A 45 year old female with history of hypertension, breast cancer after chemotherapy (including doxorubicin) and radiotherapy. An echocardiography showed decreased left ventricular systolic function. Because of chest pain, the patient was referred to stress cardiac MRI for further evaluation.MEDICATIONS: clonazepam, lisinopril, metoprolol, tamoxifen, venlafaxine, zolpidem 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 56%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 174 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 75 ml (normal range 31+/-10), the LV mass index is 30 g/m2, and the LV mass is 73 g. There are no regional wall motion abnormalities present.No thrombus is present.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 62 ml/m2 (normal range 69+/-14), the RVEDV is 153 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. 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 no significant 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 pericardial effusion.Extracardiac FindingsThe patient is status post right lumpectomy 2012 with radiation and chemotherapy. There is a T2 iso to hypodense lesion within the right breast measuring 1.9 x 2.4 cm (301/14) that correlates to the likely coil cyst within the lumpectomy bed, as described on the recent mammogram. Dedicated imaging of this lesion was not performed. The breasts are not included in their entirety within the field-of-view.
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 56%).4. Normal RV size and systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.