31 year old healthy male presenting with chest pain and positive troponins without evidence of coronary obstruction. Left VentricleThe left ventricle is normal in size with low normal systolic function. There is mild hypokinesis of the apical inferior and septal walls. There is concentric mild left ventricular hypertrophy (IVSd=11-12mm). The overall LV ejection fraction is 53%, the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVEDV is 189 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 101 g (normal range 164+/-36). On T2-weighted imaging, there is increased signal involving the basal anteroseptum, mid anterior, anteroseptum, inferoseptal, and inferior walls, and the apical septum. These findings correspond to the presence of myocardial edema. There is no obvious late gadolinium enhancement to suggest underlying myocardial fibrosis or scar.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function . The overall RV ejection fraction is 45%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 191 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 86 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.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.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 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. A small pericardial cyst is noted near the left atrial appendage. 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. Normal LV size, mild left ventricular hypertrophy, and low normal systolic function (LVEF 53%). There is mild hypokinesis of the apical inferior and septal walls. 2. There is significantly increased T2-signal involving the basal anterior wall; mid anterior, septum, and inferior walls, and the apical septum. There is no or global late gadolinium enhancement. These findings support the diagnosis of Takotsubo cardiomyopathy (especially given the rapid improvement in LVEF when compared to echo from a few days ago); however, the differential diagnosis also includes myocarditis. 3. Normal RV size with mildly reduced systolic function (RVEF 45%).4. A small pericardial cyst is noted near the left atrial appendage. When compared to the echo from 10/8/2015, the LVEF is significantly improved, as is the regional wall motion abnormality. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.