61 year old male with a history of Hypertension, Hyperlipidemia, obstructive sleep apnea, pulmonary embolism (2013) and Diabetes. Referred for vasodilator stress cardiovascular MRI due to SOB with exertion and new T-wave inversion on EKG.MEDICATIONS: Warfarin, Simvastatin, HCTZ/aliskiren, Amlodipine, Irbesartan, Maxair, Flonase, Omeprazole. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction and the entire myocardium is viable. However, there is a small amount of late gadolinium enhancement in an atypical pattern which involves the basal inferior and inferolateral wall suggesting the presence of myocardial fibrosis, inflammation, or infiltration, such as might be seen with old myocarditis.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 71ml/m2 (normal range: 74+/-15), the LVEDV is 189 ml (normal range 142+/-34), the LV end systolic volume index is 19 ml/m2 (normal range 25+/-9), the LVESV is 52 ml (normal range 47+/-19), the LV mass index is 52 g/m2, and the LV mass is 140 gm. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is mildly enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 244 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 107 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly 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 no significant tricuspid regurgitation.AortaThe aortic root is mildly dilated (42 x 43mm). 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 mildly dilated (32mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis 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 72%) with evidence of a small amount of late gadolinium enhancement in a pattern atypical for prior myocardial infarction and suggestive of myocardial fibrosis, inflammation, or infiltration. The abnormality most likely represents old myocarditis; however, other possibilities remain on the differential diagnosis.4. Normal RV size and systolic function (RVEF 56%).5. Mildly dilated ascending aorta.6. Mildly dilated main pulmonary artery.