A 68 year old male with history of coronary artery disease, s/p coronary artery bypass surgery (LIMA to LAD, RIMA to RCA, SVG to OM), s/p PCI to LAD. Recently the patient complaint of progressive dyspnea on exertion. After review of last coronary angiogram, the patient is referred to stress cardiac MRI to evaluate ischemia.MEDICATIONS: Aspirin, Atorvastatin, Clopidogrel, Metoprolol, Levothyroxine, Nitro as needed. First Pass PerfusionDuring hyperemia, perfusion abnormalities were noted in the basal anteroseptum, inferoseptum, inferior, inferolateral, and anterolateral walls; the mid anteroseptum, inferoseptum, and inferior walls; and the apical inferior and septal walls. The overall ischemia score is 10 out of a possible 32 and 31% of the myocardium is ischemic. 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 and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 71 ml/m2 (normal range: 74+/-15), the LVEDV is 147 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 42 g/m2, and the LV mass is 87 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 174 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 80 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 mild 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 FindingsSternal wires were 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 burden of "ischemia" as described above.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 55%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 54%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.