79 year old woman with dyspnea on exertion, referred for evaluation of underlying ischemia. MEDICATIONS: ASA, lipitor, lasix, HCTZ First Pass PerfusionDuring hyperemia, there is a subtle subendocardial perfusion defect involving about half of the wall thickness of the entire base and mid-ventricle. There is a small defect of moderate severity in the mid inferolateral wall. 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. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 54 ml/m2 (normal range: 65+/-11), the LVEDV is 85 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 28 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 57 g. There are no regional wall motion abnormalities present. 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 56%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 99 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 44 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 moderate 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 FindingsThere is increased linear signal in the right upper lung and a second pleural based abnormality in the mid lung. These findings were previously better visualized on the chest CT scan from 10/2015. This 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. During hyperemia, there is a subtle subendocardial perfusion defect involving about half of the wall thickness of the entire base and mid-ventricle. There is a small defect of moderate severity in the mid inferolateral wall. I suspect these abnormalities are predominantly related to microvascular dysfunction rather than epicardial coronary artery disease. 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 56%).5. Moderate tricuspid regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.