60 year old male with unstable angina, worsening ejection fraction and anterior wall motion abnormality, assess for viability with dobutamineMEDICATIONS: metoprolol, aspirin, plavix, midodrine, ranolazine Viability/ Myocardial ScarThere is a non-transmural myocardial infarction involving the mid anterior wall. There is a second non-transmural myocardial infarction involving the basal inferoseptum and basal to mid inferior wall. All of these segments have an intermediate probability of viability. Following infusion of 20mcg/kg/min of dobutamine there is augmentation of the overall ejection fraction. However, the basal to mid inferior wall and basal inferoseptal wall do not augment significant, suggesting these segments are less likely to be viable. The mid anterior wall, on the other hand, has improved contractility suggesting this segment is viable. The remainder of the myocardium is free of myocardial infarction and viable. Left VentricleThe left ventricle is normal in size with systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 170 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 65 g/m2, and the LV mass is 148 g. At rest, there is hypokinesis of the myocardium in the basal and mid inferior walls and the basal inferoseptum. Additionally there is hypokinesis of the mid anterior wall.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 146 ml (normal range 142+/-31), the RV end systolic volume index is 27 ml/m2 (normal range 31+/-9), and the RVESV is 61 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.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 a non-transmural myocardial infarction involving the mid anterior wall which is likely to be viable. There is a second non-transmural myocardial infarction involving the basal inferoseptum and basal to mid inferior wall; these segments are not likely to be viable. The remainder of the myocardium is free of myocardial infarction and viable. 2. Normal LV size and systolic function (LVEF 57%) with resting regional wall motion abnormalities in the (1) basal to mid inferior wall and basal inferoseptum and in the (2) mid anterior wall.3. Normal RV size and systolic function (RVEF 59%).4. Mild left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.