71 year old female with known coronary artery disease, shortness of breath, and evidence of micronodules on her lungs. She is referred to rule out ischemia and infiltrative processes. MEDICATIONS: amlodipine, rosuvastatin, aspirin First Pass PerfusionDuring hyperemia, a mild perfusion defect was noted in the basal anterior wall; mid anteroseptum, anterior, and anterolateral walls; and in the apical septum, anterior, lateral, and inferior walls.Viability/ Myocardial ScarThere was evidence of a moderate amount of late gadolinium enhancement in the pattern of a stripe along the anterolateral wall which spares the endocardium. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. 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 with mild concentric left ventricular hypertrophy. The overall LV ejection fraction is 71%, the LV end diastolic volume index is 53 ml/m2 (normal range: 65+/-11), the LVEDV is 94 ml (normal range 109+/-23), the LV end systolic volume index is 16 ml/m2 (normal range 18+/-5), the LVESV is 28 ml (normal range 31+/-10), the LV mass index is 52 g/m2, and the LV mass is 92 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 70%, the RV end diastolic volume index is 51 ml/m2 (normal range 69+/-14), the RVEDV is 90 ml (normal range 110+/-24), the RV end systolic volume index is 15 ml/m2 (normal range 22+/-8), and the RVESV is 27 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. There is a subaortic membrane with evidence of flow acceleration in the LVOT, correlation with echocardiogram suggested to determine peak gradient.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 FindingsThis 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. A mild perfusion defect/ "ischemia" is noted in much of the left anterior descending artery territory as described above. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 71%) with mild, concentric left ventricular hypertrophy. There was evidence of a moderate amount of late gadolinium enhancement in the pattern of a long thin stripe along the anterolateral wall which spares the endocardium. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. 4. Normal RV size and systolic function (RVEF 70%).5. Mild to moderate left atrial dilation.6. A subaortic valve membrane is noted and associated with flow acceleration in the LVOT. Correlation with echocardiography suggested.Findings discussed with referring physician. 