65 year old with history of coronary artery disease with drug eluting stent to the proximal right coronary artery, hypertension, dyslipidemia, known mitral regurgitation and COPD presenting prior to potential shoulder surgery. MEDICATIONS: amlodipine, aspirin, atorvastatin, metoprolol, symbicort, tamsulosin and spiriva. First Pass PerfusionDuring hyperemia, there is a large perfusion defect which involves the basal anterolateral and inferolateral walls; the mid anterolateral, inferolateral, and inferior walls; and the apical lateral and inferior walls. The overall ischemia score is 8 out of a total of 32 and involves 25% of the myocardium.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 normal in size with normal systolic function. There is mild hypokinesis of the mid anterolateral, inferolateral, and inferior walls; and the apical inferior wall. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 154 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 67 g/m2, and the LV mass is 144 g. Left AtriumThe left atrium is mildly dilated (111ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVEDV is 129 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 57 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 moderate to severe mitral regurgitation. There is both evidence of mild mitral prolapse and also "ischemic" mitral regurgitation via tethering of the posterior leaflet due to the above mentioned wall motion abnormalities.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 mildly dilated (Sinus of Valsalva 42mm and Ascending Aorta 41mm). There is a left sided aortic arch with a pseudo-bovine 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 FindingsThe lungs are hyper-inflated. 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 amount of ischemia, as described above.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 56%) with mild hypokinesis of the mid anterolateral, inferolateral, and inferior walls and the apical inferior wall.4. Normal RV size and systolic function (RVEF 56%).5. There is moderate to severe mitral regurgitation, likely secondary to both mitral valve prolapse and ischemic mitral regurgitation. 