Impression:
Fixed moderate reduced uptake in the apex, the apical half of the anterior wall, and the apical third of the septal-inferior-lateral walls --consistent with nontransmural MI (arrows) (9/25 segments) (LAD territory).
Severe ischemia in the residual myocardium in apex, anterior wall, septum and apical third of the lateral and inferior walls (small lines) (14/25 segments) (LAD territory). The extent of ischemia is about 40-45% of the total myocardial volume by quantification, and the ischemic severity score is very high .
Coronary Angiography:
LAD - 90% stenosis
RCA - 40-50% stenosis
LCx - Normal
Anterior wall hypokinesis
LVEF=54%
Echocardiography:
Hypokinesis / akinesis of the anterior septal and anterior apical portions of the myocardium
LVEF=48%
Comments:
Silent MI and silent severe and extensive ischemia!! This is a high risk patient.
The baseline ECG revealed a prior MI. The stress test (ECG and symptoms) did not disclose the severity of the disease.
The increase in LV cavity size is just an effect of the severe and extensive residual ischemia.
