LV Volume / Pressure Overload

Dilated CMP

FINDINGS
IMPRESSION
FULL SIZE (large) . . . SCREEN SIZE
IMAGES
HISTORY
(TUTORIAL)
TITLE PAGE
FULL SIZE (large) . . . SCREEN SIZE
CONTENTS
PREVIOUS
CASE
NEXT CASE
Impression:

  • Marked increased LV volume (3+).

  • Moderate increased RV uptake (2+) -- consistent with RV pressure overload.

  • Moderate decreased perfusion in the inferior wall at rest (white arrows) -- consistent with nontransmural MI (RCA territory).

  • Mild decreased perfusion in the posterior septum during stress(white lines)-- consistent with mild ischemia (3/25 segments) (RCA territory).

  • Late fill-in in the inferior wall and posterior septum on the delayed images (green lines) -- consistent with hibernating myocardium in the area of injury (RCA territory).

  • Discrepancy betveen LV volume and perfusion defects consistent with LV volume overload condition (CMP? valve disease?).

    ECHO:

  • LV dilatation with severely reduced and abnormal systolic function. Estimated EF is 10-15%.
  • RV dilatation with moderate RV dysfunction.
  • No evidence of valve dysfunction.
  • Evidence of moderate severe pulmonary hypertension.

    Comments:
    It was later revealed that the patient was a heavy drinker (> 10 drinks / day). Alcoholic CMP is a likely diagnosis. However, only by demonstration of improvement of function after abstinens can prove this diagnosis.

    • 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.