RV Pressure Overload

Ischemic Cardiomyopathy

FINDINGS
IMPRESSION
Marked image/s of the study (3.5 inch wide)
FULL SIZE (large) . . . SCREEN SIZE
IMAGES
HISTORY
(TUTORIAL)
TITLE PAGE
CONTENTS
PREVIOUS
CASE
NEXT CASE
Note:Angiograpfic,ECHO, and Cathterization findings given below impression

Impression:

  • Markedly increased LV volume (3+).
  • Moderate increase in RV uptake (2+).
  • Mixed transmural / nontransmural MI in the inferolateral wall (arrows) (5/25 segments) (RCA territory).
  • Moderate-to-severe ischemia in the apical 2/3 of the lateral and anterolateral walls (6/25 segments) (small lines).

    Coronary angiography:

  • LAD - 30% proximal and 40% midportion stenosis; 1st diagonal branch - totally occluded with left-to-left collaterals.
  • LCX - 80% proximal stenosis.
  • RCA - totally occluded.

    ECHO:

  • Marked LV dilatation with moderate reduction of systolic function. EF=35%.
  • Extensive inferior-posterior-lateral walls motion abnormality.
  • Mild TR and AR (1+) and moderate MR (2+).

    Cardiac catheterization:

  • RV - 38/8
  • PCW - 13/14/11
  • PAP - 38/14

    Comments:
    The LV volume is markedly increased while the rest perfusion abnormalities are moderately extensive and severe. The LV volume appears somewhat larger than the rest perfusion abnormalities can explain. An additional factor may be in effect.
    An MR (2+) was found on Doppler. The concomitant MR probably provides additional volume overload leading to the observed degree of LV dilatation. The systolic LV function is only mild to moderately impaired (ECHO LVEF=35%), further increasing the likehood of the above scenario.
    The increased RV uptake indicate RV pressure overload and pulmonary hypertension (backward failure) confirmed by cardiac cathetherizaton . The MR plays a very significant role in this patient's total picture.

    • MARKED IMAGES (TOP)
    Atlas of Myocardial Perfusion SPECT
    © Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
    Comments and errors to atlasspect@yahoo.com
    Contributions and case related information through     Fmannting@bics.bwh.harvard.edu

    Please include URL reference with correspondence
    Initiated: Nov 19, 1995. Last updated: April 26, 1999.