84-year-old male with ischemic cardiomyopathy, coronary artery disease, DM, HTN and CHF. Because of limited function capacity, patient is referred to rule out ischemia for pre-operative risk assessment prior to hip surgery. MEDICATIONS: Amlodipine, aspirin, carvedilol, ergocalciferol, multivitamin, lovaza, quinapril, simcor, xarelto. First Pass PerfusionDuring hyperemia, a perfusion defect corresponding with the below described myocardial infarction is noted. No ischemic territories are present.Viability/ Myocardial ScarThere is a large, predominantly, transmural myocardial infarction involving the basal and mid inferoseptal, inferior, and inferolateral walls. Additionally, the apical inferior wall is involved. These infarcted myocardial segments are predominantly not viable and are the cause of the above described perfusion defect. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 145 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 76 g/m2, and the LV mass is 125 g. There is subtle hypokinesis of the basal to mid inferior wall and the basal inferolateral wall.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMultiple, large, bilateral renal cyst are noted. Sternal wires are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.
1. There is a large mostly transmural myocardial infarction involving the above described walls. This infarction is predominantly not viable. The remainder of the myocardium is free of myocardial infarction and viable. There are no areas of residual myocardial ischemia.2. Normal LV size and systolic function (LVEF 62%). There is subtle hypokinesis of the basal to mid inferior wall and the basal inferolateral wall.3. Normal RV size and systolic function (RVEF 51%).4. See extracardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.