65 year old male with a history of multiple arrhythmias including non-sustained ventricular tachycardia and frequent PVCs, supraventricular tachycardia, and paroxysmal atrial fibrillation who is referred for cardiac MRI for further evaluation.MEDICATIONS: Atenolol and Aspirin. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Dark rim artifact is noted at stress and rest. Viability/ Myocardial ScarThere is evidence of mid-myocardial late gadolinium enhancement in the basal inferior and inferolateral, basal anteroseptum, and apical right ventricular insertion site. These patterns are not typical for prior myocardial infarction and suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is moderately dilated with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 244 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 117 ml (normal range 47+/-19), the LV mass index is 34 g/m2, and the LV mass is 66 g. There is global hypokinesis. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 128 ml/m2 (normal range 82+/-16), the RVEDV is 245 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 109 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. 3. The left ventricle is moderately dilated with low normal systolic function (LVEF 52%) and evidence of myocardial fibrosis, inflammation, or infiltration as described above. 4. The right ventricle is mildly dilated with normal systolic function (RVEF 56%).5. Severe biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.