82 year old woman with dyspnea, referred for evaluation of underlying ischemia. MEDICATIONS: Toprol XL, gemfibrozil, Crestor, nifedipine. First Pass PerfusionDuring hyperemia, there is a perfusion defect (ischemia) in the basal to mid inferior wall and the basal inferoseptum. Viability/ Myocardial ScarThere probably a nontransmural myocardial infarction involving the basal inferior and inferoseptal walls which has an intermediate probability of viability. The mid inferior wall has no evidence of prior myocardial infarction and is viable. The remainder of the coronary territories are free of myocardial infarction and viable.Left VentricleThe left ventricle is normal in size with normal systolic function. There is hypokinesis of the basal to mid inferior wall. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), the LVEDV is 126 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 50 g/m2, and the LV mass is 88 g. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 85 ml (normal range 110+/-24), the RV end systolic volume index is 17 ml/m2 (normal range 22+/-8), and the RVESV is 31 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild 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 ascending aorta is mildly dilated (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 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 FindingsTrace bilateral pleural effusions. 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. In the typical territory of the RCA, there is evidence of hypokinesis associated with a non-transmural myocardial infarction with residual peri-infarct ischemia and an intermediate probability of viability. 2. There is no ischemia or myocardial infarction in the typical territory of the LAD and LCx.3. Normal LV size and systolic function (LVEF 61%).4. Normal RV size and systolic function (RVEF 64%).5. Mild dilation of the ascending aorta.6. Mild aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.