A 47 year old female with hyperlipidemia, coronary artery disease with a non-ST elevation myocardial infarction (8/2015) with significant stenosis of the proximal circumflex which was opened with a stent. Because of recurrent chest pain a new catheterization on 9/2015 showed patent stent with no other stenosis. Referred to stress cardiac MRI for further evaluation.MEDICATIONS: amlodipine, aspirin, atorvastatin, brilinta, clonazepam, cymbalta, metoprolol, nitrostat. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Quantitative analysis by myocardium perfusion reserve index showed normal values (1.73).Viability/ Myocardial ScarThere is late gadolinium enhancement in the inferior wall at the base and middle segments and in the infero-lateral wall at the base. This finding is in a coronary pattern and compatible with an infarct. This high signal enhancement involves approximately 80% of the thickness of the wall and thus suggest likely no viability in this area. Left VentricleThe left ventricle is normal in size with low-normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 69 ml/m2 (normal range: 65+/-11), the LVEDV is 122 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 57 ml (normal range 31+/-10), the LV mass index is 43 g/m2, and the LV mass is 75 g. There is hypokinesis in the inferior wall at the base and middle segments and in the infero-lateral wall at the base. There is no intracardiac thrombus.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 60%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). 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 pericardial effusion.Extracardiac FindingsBilateral breast prosthesis.
1. During hyperemia, no perfusion defects were present. Quantitative analysis by myocardium perfusion reserve index showed normal values (1.73).2. There is late gadolinium enhancement in the inferior wall at the base and middle segments and in the infero-lateral wall at the base. This finding is in a coronary pattern and compatible with an infarct. This high signal enhancement involves approximately 80% of the thickness of the wall and thus suggest likely no viability in this area. 3. Normal LV size and systolic function (LVEF 53%). There is hypokinesis in the inferior wall at the base and middle segments and in the infero-lateral wall at the base. 4. Normal RV size and systolic function (RVEF 60%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.