Reason: CHF, CAD, new conduction abnormailities, ?viable myocardium History: DOE Left VentricleThe left ventricle is normal in size. There is global mild hypokinesis. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 180 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 72g/m2 (normal range 85+/-15), and the LV mass is 131 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest myocardial infarct.No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 158 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17). No evidence of right heart strain.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. The anterior leaflet is thickened. There is mitral regurgitation, estimated to be mild. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation directed posteriorly, reported to be severe on recent echocardiogram. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. Within the right inferior lobar pulmonary artery and several lower lobe segmental branches, non occlusive foci of low signal are highly suspicious for pulmonary emboli (401/16 and (501/32). Potential small segmental and subsegmental pulmonary artery filling defects cannot be entirely excluded.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac FindingsModerate right and small left pleural effusions. A peripheral triangular high signal focus is suspicious for pulmonary infarct (2201/1). There is apparent bronchial wall thickening in the right lower lobe with right upper and lower lobe parenchymal areas of high signal. This may be sequelae of aspirated blood.
1. No left ventricular myocardial enhancement to suggest an infarct. LVEF = 50% due to global mild hypokinesis.2. Low signal foci within the right inferior lobar and segmental pulmonary arteries highly suspicious for pulmonary emboli. This can be confirmed with CTA PE thorax if clinically appropriate.3. There is apparent bronchial wall thickening in the right lower lobe with parenchymal areas of high signal. This may be sequelae of aspirated blood.