80 year woman with chest pain and non-sustained ventricular tachycardia referred to rule out ischemia and evaluate for myocardial damage.MEDICATIONS: aspirin, atorvastatin, azilisartan, carvedilol, torsemide. First Pass PerfusionDuring hyperemia, the patient has a mild, small perfusion defect in the mid septum and in the mid inferolateral wall. The overall ischemia score is 2 out of 32 and involves 6% of the myocardium.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 mildly hypertrophied but normal in size and systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 139 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 44 ml (normal range 31+/-10), the LV mass index is 85 g/m2, and the LV mass is 153 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 143 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 67 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 to moderate mitral regurgitation. The posterior mitral valve is thickened and has restricted motion. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 no obvious pericardial disease. A trace pericardial effusion is noted.Extracardiac FindingsThere is a large hiatal hernia with proximal dilation of the esophagus. Trace bilateral pleural effusions are present. 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 mild, small burden of the ischemia involving the mid inferolateral and mid septal walls.2. No prior myocardial infarction. The entire myocardium is viable.3. Mild left ventricular hypertrophy with normal LV size and systolic function (LVEF 68%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 53%).5. Severe left atrial dilation.6. Mild to moderate mitral regurgitation with restricted motion of the posterior leaflet.7. Large hiatal hernia with proximal esophageal dilation. Of note, patient was significantly hypertensive (systolic BP 210mmHg) but improved somewhat after taking her medications (systolic BP 160mmHg).