71 year old female with history of hypertension, premature ventricular contractions and near syncope presenting for cardiac evaluation. MEDICATIONS: amlodipine, aspirin and hydrochlorothiazide First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted.Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction; however, there is a small amount of an atypical pattern of late gadolinium enhancement involving the mid myocardium in basal inferolateral wall suggesting that there is underlying myocardial fibrosis, inflammation, or infiltration. This pattern is commonly described in old myocarditis but the differential diagnosis is broad.Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), the LVEDV is 162 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 79 ml (normal range 31+/-10), the LV mass index is 39 g/m2, and the LV mass is 77 g. The systolic dysfunction is global without regional wall motion abnormalities. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 129 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 62 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 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. No perfusion defects/ "ischemia" present during hyperemia.2. Normal LV size with low normal systolic function (LVEF 52%) with evidence of an atypical pattern of a small amount of late gadolinium enhancement involving the mid-wall of the basal inferolateral wall. The pattern does not represent prior myocardial infarction or disorders such as cardiac amyloid. It is often described in patients with old myocarditis but can be seen in several other disorders.3. Normal RV size and systolic function (RVEF 52%).4. Mild mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.