A 51 year old female with hypertension, hyperlipidemia and overweight. Referred to stress cardiac MRI because of chest painMEDICATIONS: furosemide, hydralazine, lisinopril, lovastatin, metoprolol, spironolactone, amlodipine. First Pass PerfusionDuring hyperemia, there is a perfusion defect in the mid anterolateral and inferolateral wall. The overall ischemia score is 2 out of 32 and ~6% of the left ventricular mass 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 normal systolic function. There is mild concentric hypertrophy (IVSd=11mm). The overall LV ejection fraction is 67%, the LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 138 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10), the LV mass index is 32 g/m2, and the LV mass is 68 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. The interatrial septum deviates to the right suggesting increased left atrial pressure. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 67 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.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. There is a mild perfusion defect in the mid anterolateral and inferolateral walls involving ~6% of the myocardium. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 67%).4. Normal RV size and systolic function (RVEF 57%).5. Mild left atrial dilation with suggestion of increased left atrial pressure. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.