63 year old male with history of Hodgkin's lymphoma, hypertension, dyslipidemia, chronic kidney disease and coronary artery disease (on stress perfusion testing) presenting for evaluation of atypical chest pain. MEDICATIONS: valsartan, metoprolol, aspirin, rosuvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. There was matched defects present on rest and stress images consistent with artifact. Notably the lateral wall perfusion defect seen on previous imaging is no longer seen. 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, global reduced systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 227 ml (normal range 142+/-34), the LV end systolic volume index is 51 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 49 g/m2, and the LV mass is 106 g. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 91 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 three vessel arch.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 pericardial effusion.
1. No perfusion defects/ "ischemia" present during hyperemia. Compared to previous study of 12/14/2010, the lateral wall perfusion defect has resolved.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly reduced systolic function (LVEF 51%).4. Normal RV size and systolic function (RVEF 50%). 