0:01

Okay, perfect. So we're gonna move on to our course work gate

0:04

now and we're going to shift here the bit the next couple cases are

0:07

patients who presented after covid-19. So SARS

0:10

Kobe to infection not vaccination. And

0:13

again, we're going to kind of go through the cases in

0:16

a similar way and I'll try to tell you a little bit so that's what

0:19

you actually a young adult male who

0:22

presented after

0:24

Covid-19 infections itself came

0:27

chest pain and elevated chapon level so

0:30

very similar clinical picture, but the

0:33

precipitant the preceding event was

0:36

not vaccination was actually covid covid positive

0:39

SARS committee infection itself and

0:42

here I'll play the four chambers and for you

0:45

and we can see here the five

0:48

ventricular function in this case was normal. So we don't

0:51

see any Global dysfunction in all players short access.

0:55

S is that the stock again? This is helping us to

0:58

assess the size and function of the ventricles. I'm

1:01

looking can also look at how well the valves

1:04

are functioning whether there's any work regurgitation. Of course, we

1:07

would typically and as our Center require multiple long

1:10

access use. I'm just showing you the four chamber to start

1:13

with and now as I played this short access, let's go back to the base. And

1:16

again, this was also required post contrast so a clue

1:19

to look for areas of high signal intensity.

1:22

And as we come through here where the Atria we're now

1:25

moving into the basal. Myocardium, we can start to see

1:28

that there is I'm just pausing it here. So you can see an area of high signal

1:31

intensity again in that sub of bicardial myocardium

1:34

at the infilateral wall extending into the

1:37

antilateral wall. This micronism thickened not

1:40

surprisingly. There's very typical finding when

1:43

we have edema and the demon is myocardium actually becomes

1:46

thickened and there is a regional motion on

1:49

their Melody. So hopefully you can see that on this place. You see

1:52

that very nicely that area of myocardium. That's at home coming in.

1:55

It's not thickening quite as nicely as the other segment. So although our

1:58

lvf are ejection fraction and

2:01

our Global function is preserved. We can have a regional emotionality.

2:07

Let's move on to our tissue characterization sequences. So

2:10

we'll pull up teaching map on the

2:13

right and our black LED teaching in the gym on the

2:16

left here.

2:17

And this patient was having difficulty

2:20

holding their breath and you can see here that there's some artifacts but

2:23

despite that with a little bit of windowing is SOB

2:26

epicardial area of high signal intensity becomes a

2:29

parent. Here's our teaching math on the

2:32

right and you can see here even visually that there's actually

2:35

quit a large area of high signal

2:38

intensity in the stock up a cardiomaticardium at the

2:41

infra wall in collateral and a lot of wall and I'll just

2:44

show you again. You don't need to do any special Prospect

2:47

this thing. If you don't want to you don't have to quantify Global

2:50

values, you can even do very simple roi's

2:53

here 58 again above

2:56

our normal reference range at 1.5 to using the

2:59

sequence on the sequences 56 milliseconds. So

3:02

with elevated this is the patient to have an

3:05

outpatient MRI, so actually just Imaging was done.

3:08

Two weeks after their acute presentation. So

3:11

it's not the Imaging isn't quite as acute as some of the other cases

3:14

that I showed you previously were patients had their

3:17

MRI as an inpatient, but despite this

3:20

we can still see that this patient would clearly need teaching

3:23

based criteria both on the black blood teacher waited Imaging and

3:26

on our teaching math. And the thing that

3:29

I think is great striking and hopefully you're seeing the pattern here

3:32

is that if I hadn't told you that there was vaccination or

3:35

perceiving Stars Kobe to infection the pattern

3:38

of injuries quotes similar where we're seeing the abnormality

3:41

at that subupocardial info on a wall

3:44

is very similar. And so the pattern of injury isn't a

3:47

good clue to tell us what the underlying etiology

3:50

was the clinical history is absolutely critical to

3:53

understanding what the trigger for them

3:56

than my accredited in this case again, what?

4:00

And here is our Lake enhanced image some artifacts

4:03

again here. This patient is having difficulty holding

4:06

their breath as they mentioned and we'll pull up the

4:09

T1 map on the left are in the right rather. And again,

4:12

you can see the T1 mapping values are also High we have a

4:15

small effusion inferiorly and we can see that there is

4:18

about the Cardinal allergy at that

4:21

mid influent in for a lot or wall. And again, there's some artifact

4:24

here, but despite that we

4:26

This patient means both T2 based criteria and T1 base

4:29

criteria. So this is the patient who has acute myocarditis after

4:32

start coming to infection.