0:00

Okay, so our next case is a 43 year old man with a history

0:03

of N STEMI

0:05

and was found to have a chronic total occlusion to the RCA.

0:09

The exam was to evaluate for any evidence of other areas

0:14

of inducible ischemia or infarction in this territory.

0:17

And so, again, starting with our stress perfusion images,

0:21

stress across the top, rust across the bottom, basal mid,

0:25

and apical slices.

0:27

Here what we can see is at stress we have a area

0:31

of sub endocardial hypoperfusion in the basal

0:36

inferior and inferral septal segments, mid inferior segments

0:41

and apical inferior segments.

0:43

No matching defect at rest.

0:46

So this is a reversible defect in these territories.

0:51

So, you know, this is looking most likely to be ischemia.

0:55

Uh, don't really see any other territories that seem

0:58

to have issues going on here.

1:00

And so the next step with this evaluation is

1:03

to look at the LGE.

1:04

So we'll pull up the LG images next.

1:07

So working down from the base here

1:11

and really even scrutinizing carefully the RCA territory,

1:15

there's really no LGE in this region.

1:19

So again, looking like ischemia,

1:22

but no infarct in this location.

1:24

We can check the two chamber as well

1:26

to sort of cross reference.

1:29

Again, I don't see anything on here

1:31

that looks like Lake Catalan enhancement.

1:33

So if we go down and look at our CNA images, just

1:37

to make sure there's no evidence

1:38

of regional motion abnormality can work through here.

1:44

And the function in these locations look really good.

1:48

So no sign of hibernating myocardium, no other areas

1:52

of regional motion abnormalities.

1:54

So this case is most consistent with ischemia

1:58

and the RCA territory.