61 year old with unknown past medical history presenting with worsening dyspnea on exertion and pleuritic chest pain. MEDICATIONS: None prior to arrivalInpatient medications: captopril, lasix IV First Pass PerfusionDuring hyperemia, there is a large perfusion defect of moderate severity involving the basal inferior and inferolateral, mid inferior and inferolateral, apical inferior and lateral walls, corresponding to the usual territory of a large circumflex artery.Viability/ Myocardial ScarThere was a myocardial infarction present. It is non-transmural in the basal to mid inferior and inferolateral walls. It is transmural in the apical inferior and lateral wall. This corresponds to the territory of a large circumflex artery. Most of this large territory has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and highly likely to be viable. Left VentricleThe left ventricle is moderately dilated with moderate to severely reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 133 ml/m2 (normal range: 74+/-15), the LVEDV is 220 ml (normal range 142+/-34), the LV end systolic volume index is 93 ml/m2 (normal range 25+/-9), the LVESV is 155 ml (normal range 47+/-19), the LV mass index is 105 g/m2, and the LV mass is 175 g. The left ventricular dysfunction appears to be global; however, there is additional hypokinesis of the inferolateral wall.Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size with mildly reduced function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 106 ml/m2 (normal range 82+/-16), the RVEDV is 177 ml (normal range 142+/-31), the RV end systolic volume index is 61 ml/m2 (normal range 31+/-9), and the RVESV is 101 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated. 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 a moderate left pleural effusion and a small right pleural effusion. There is an infiltrate in the right middle lung and either an infiltrate or atelectasis in the left lower lung. 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. There is a wall motion abnormality and ischemia in the usual territory of a large circumflex artery. Most of the territory has an intermediate probability of viability. The remainder of the myocardium is highly likely to be viable but is without obvious evidence of ischemia. 2. There is a large, predominantly non-transmural myocardial infarction in the left circumflex artery territory. 3. Moderate LV dilation, mild LVH, and moderate to severe systolic dysfunction (LVEF 30%). 4. Normal RV size with mildly reduced systolic function (RVEF 43%).5. Moderate biatrial dilation.6. See extra-cardiac findings. 