49 year old woman with a history of possible adriamycin cardiomyopathy and prior history of breast cancer. She presents with fatigue and is referred to rule out ischemia and evaluate cardiac structure and function.MEDICATIONS: aspirin, lisinopril First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark rim artifact was noted on the basal slice.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 106 ml/m2 (normal range: 65+/-11), the LVEDV is 174 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 39 g/m2, and the LV mass is 64 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with normal systolic function. The shape of the right ventricular base is distorted by compression from the sternum; however, there is no evidence that this is causing a hemodynamic problem. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 112 ml/m2 (normal range 69+/-14), the RVEDV is 185 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. 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 FindingsMild sternal deviation (but enough to describe it as pectus excavatum) is 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Moderate LV dilation with normal wall thickness and systolic function (LVEF 62%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Moderate RV dilation with normal systolic function (RVEF 57%). The shape of the right ventricular base is distorted by compression from the sternum; however, there is no evidence that this is causing a hemodynamic problem. 5. Moderate biatrial dilation. 