53 year old male with history of hypertension, diabetes admitted with acute decompensated heart failure and pericardial effusion now s/p pericardiocentesis. MEDICATIONS: atorvastatin, lisinopril, carvedilol, furosemide First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is linear mid myocardial gadolinium enhancement in the basal to apical inferior, inferolateral and lateral walls. This is atypical for myocardial infarction. In the setting of wall motion abnormality and pericardial effusion, this is suspicious for myocarditis. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 247 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 144 ml (normal range 47+/-19), the LV mass index is 64 g/m2, and the LV mass is 154 g. The left ventricular systolic dysfunction is global with regional variation, specifically with hypokinesis in the inferolateral, inferior and lateral walls. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 209 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 129 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild 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 a small pericardial effusion. There is no abnormal thickening in the pericardium is present. Extracardiac FindingsSmall bilateral pleural effusions. There is high signal in the left superior major fissure suggestive of loculated fluid with scarring.
1. Mid-myocardial enhancement in the basal to apical inferior, inferolateral and lateral walls, systolic dysfunction with small pericardial effusion suggestive of a myocarditis/perimyocarditis. 2. No perfusion defects/ "ischemia" present during hyperemia.3. Normal LV size with mildly reduced systolic function (LVEF 42%).4. Normal RV size with mild to moderately reduced systolic function (RVEF 39%).5 Biatrial enlargement.