A 72 year old female with hypertension, hyperlipidemia, breast cancer, s/p chemotherapy and now on herceptin, family history of premature coronary artery disease. The electrocardiogram showed anterior ST-T abnormalities and the echocardiography (6/30/2015) showed LVEF of 30% with normal LV function. Referred to cardiac MRI for further evaluation MEDICATIONS: vitamin D3, clonazepam, metoprolol, zolpidem. First Pass PerfusionDuring hyperemia, no perfusion defects were present. 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 65%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 119 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 85 g. There are no regional wall motion abnormalities present. No intracardiac thrombus. Left AtriumThe left atrium is normal size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is normal size. Aortic ValveThe aortic valve is trileaflet and opens widely. 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 trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta is non aneurysmal, measuring 3.6 x 3.7 cm (non orthogonal measurement).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.Extracardiac FindingsThere is an incidental lipoma of the right subscapularis musculature.A 2.6 x 3.2cm T2 high signal lesion occupies the left breast with surrounding striations, favoring appearance of post operative seroma that is unchanged from recent ultrasound.
1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%).4. Normal RV size and systolic function (RVEF 59%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.