23 year old with history of recent pregnancy and hypertension admitted with acute stroke, found to have new left ventricular dysfunction and apical thrombus on echocardiogram. Left VentricleThe left ventricle is severely dilated, severely reduced systolic function and moderate left ventricular hypertrophy. The overall LV ejection fraction is 25%, the LV end diastolic volume index is 153 ml/m2 (normal range: 65+/-11), the LVEDV is 284 ml (normal range 109+/-23), the LV end systolic volume index is 115 ml/m2 (normal range 18+/-5), the LVESV is 213 ml (normal range 31+/-10), the LV mass index is 109 g/m2 (normal range 67+/-11), and the LV mass is 203 g (normal range 114+/-24). The left ventricular dysfunction is global. There is no clear late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Due to significant motion artifact (despite multiple attempts) small areas of LGE cannot be excluded. No left ventricular thrombus seen. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with moderate to severely reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 127 ml/m2 (normal range 69+/-14), the RVEDV is 235 ml (normal range 110+/-24), the RV end systolic volume index is 91 ml/m2 (normal range 22+/-8), and the RVESV is 169 ml (normal range 35+/-13). Right AtriumThe right atrium is mild to moderately dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is upper limits normal (30 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a small pericardial effusion. Extracardiac FindingsThere is local susceptibility artifact at the dependant gastric fundus of uncertain etiology. No metal is visible on previous imaging exams. Correlation to possible ingested items recommended and can be followed with abdominal radiograph.
1. The left ventricle is severely dilated, severely reduced systolic function and moderate left ventricular hypertrophy. The overall LV ejection fraction is 25% The left ventricular dysfunction is global. There is no clear late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Due to significant motion artifact (despite multiple attempts) small areas of LGE cannot be excluded. 2. The right ventricle is moderately dilated with moderate to severely reduced systolic function. The overall RV ejection fraction is 28%. 