72 year old male with a history of coronary artery disease (s/p multiple PCI, last 3/1/16, DES to 2nd diag), Mobitz type I heart block, pulmonary fibrosis, and CKD presenting as a transfer from OSH for c/f in-stent thrombosis Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 183 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 81 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 119 g (normal range 164+/-36). There are wall motion abnormalities in the mid to apical anterior and anteroseptal walls. There is transmural late gadolinium enhancement in a pattern consistent with myocardial infarction in the apical to mid anterior, lateral, anterolateral walls. These areas are unlikely to be viable. The remaining myocardium is likely to be viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 129 ml (normal range 142+/-31), the RV end systolic volume index is 21 ml/m2 (normal range 31+/-9), and the RVESV is 46 ml (normal range 54+/-17).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.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.Extracardiac FindingsThe left left hemidiaphragm is elevated. Bilateral pulmonary fibrosis with upper lobe predominance.
1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%.There are wall motion abnormalities in the mid to apical anterior and anteroseptal walls. There is transmural late gadolinium enhancement in a pattern consistent with myocardial infarction in the apical to mid anterior, lateral, anterolateral walls. These areas are unlikely to be viable. The remaining myocardium is likely to be viable. 2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 65%