29 year old with history of hypertension and peripartum cardiomyopathy presenting for cardiac evaluation. MEDICATIONS: Amlodipine, aspirin, atorvastatin, furosemide, metoprolol, spironolactone, valsartan First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted.Viability/ Myocardial ScarThere is no late gadolinium enhancement to suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is severely enlarged with moderately reduced systolic function. There is mild circumferential left ventricular hypertrophy (IVSd=10mm). The overall LV ejection fraction is 38%, the LV end diastolic volume index is 153 ml/m2 (normal range: 65+/-11), the LVEDV is 287 ml (normal range 109+/-23), the LV end systolic volume index is 95 ml/m2 (normal range 18+/-5), the LVESV is 179 ml (normal range 31+/-10), the LV mass index is 65 g/m2, and the LV mass is 121 g. The left ventricular systolic dysfunction is global. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is severely enlarged with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 146 ml/m2 (normal range 69+/-14), the RVEDV is 274 ml (normal range 110+/-24), the RV end systolic volume index is 72 ml/m2 (normal range 22+/-8), and the RVESV is 136 ml (normal range 35+/-13). 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 no significant mitral regurgitation.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 pseudo-bovine brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsA large left axillary lymph node (15mm) is noted. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. LV is severely dilated with moderately reduced systolic function (LVEF 38%).4. RV is severely dilated with normal systolic function (RVEF 51%).5. Significant biatrial dilation. 6. Large left axillary lymph node noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.