LV Volume / Pressure Overload

LV Dilatation Sec to AS / AR and MR

FINDINGS
IMPRESSION
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Impression:

  • Markedly increased LV volume (3+).
  • Mild fixed reduced uptake in the inferolateral wall at rest (arrows) -- consistent with nontransmural MI (6/25 segments), and mild transient changes (small lines) -- consistent with mild peri-infarct ischemia and ischemia in the residual myocardium (4/25 segments) (RCA territory).
  • Discrepancy between extent and severity of perfusion abnormalities and the LV volume consistent with LV volume overload condition (CMP ?, valve disease ?).

    Coronary angiography

  • RCA - 40% stenosis

    ECHO

  • Moderate LV dilatation with moderately reduced systolic function. EF=35%.
  • Extensive inferior-posterior akinesis to mild dyskinesis is seen with thinning, consistent with scarring.
  • Aortic valves thickened and calcified. AS 3+, AR 1-2+.
  • Mitral annular calcification. MR 2+.

    Comments:
    The LV volume is markedly increased while the rest perfusion abnormalities are at most moderately extensive and severe.The LV volume is clearly larger than would be expected if due to ischemic disease only.

    Global systolic LV function by ECHO only mild to moderate impaired, thus matching the extent and severity of myocardial injury. The RCA has only 40% stenosis on angiography, however this is static measurement, in this patient this degree of the RCA disease is clearly significant. Valvular disease is obvious and is with all likehood the etiology of the LV dilatation.

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    Atlas of Myocardial Perfusion SPECT
    © Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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    Initiated: Nov 19, 1995. Last updated: April 26, 1999.