47 year old with hypertension presenting for evaluation of atypical chest pain. MEDICATIONS: amlodipine, aspirin, atorvastatin, metoprolol XL First Pass PerfusionDuring hyperemia, no perfusion defects were present. 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 normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 211 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 56 g/m2, and the LV mass is 119 g. There are no regional wall motion abnormalities present. Native T1 times are normal 955 ms. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 200 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size. .Aortic ValveThe aortic valve is trileaflet, 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 trivial tricuspid regurgitation.AortaThe aortic root is borderline in size (sinus of Valsalva 40 mm). The ascending thoracic aorta is dilated (46 mm 4 cm above the aortic valve plane). No obvious thoracic aortic dissection. 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 FindingsThe esophagus appears mildly dilated. A large subcarinal mass (probably lymph node) is noted (cross sectional diameter 2-2.5cm). 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. Normal LV size and systolic function (LVEF 64%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 55%).5. Dilated ascending thoracic aorta at 46 mm without evidence of obvious thoracic aorta dissection.6. Large subcarinal mass, probably lymph node.