70 year old man with history of coronary artery disease s/p PCI who presents with chest pain. Cardiac MRI done to evaluate for ischemia.MEDICATIONS: amlodipine, HCTZ, losartan, isordil, rosuvastatin First Pass PerfusionDuring hyperemia, a perfusion defect is noted in the basal inferoseptum, inferior, and inferolateral walls; mid anteroseptal, anterior, anterolateral, inferolateral, inferior, and inferoseptal walls; and the apical anterior, inferior, and septal walls. The overall ischemia score is 16 out of a possible 32, and 50% 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 with mild to moderate systolic dysfunction. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 172 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 101 ml (normal range 47+/-19), the LV mass index is 61 g/m2, and the LV mass is 130 g. There is global hypokinesis with a greater degree of hypokinesis of the basal inferoseptum and the basal to mid inferior walls.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 51%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 130 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 63 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 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. There is an extensive burden of ischemia involving the usual territory of the LAD, LCx, and RCA. The ischemia is worst in the basal to mid inferoseptum, inferior, and inferolateral walls.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with mild to moderately reduced systolic function (LVEF 41%).4. Normal RV size and systolic function (RVEF 51%).