Acute Myocardial Infarction
67 year old female patient, with the following relevant medical history:
The patient is admitted in the emergency room due to intense retrosternal pain and nausea. In the ECG a ST elevation in DII, DIII, and aVF can be observed. A primary PCI is performed. The coronariography shows a total occlusion of the distal RCA (Figure 1). A drug-eluting stent is implanted.
During the hospital stay a cardiac MRI is performed.
Video 1 shows cine imaging at rest. The left ventricle has a normal size (diameter 50 mm at end-diastole), is hypertrophied (basal septum 17 mm), and has a normal global function (EF 57%). A hypokinesia of the basal and medial inferior and inferoseptal segments (segments 3, 4, 8, and 9) can be observed. Figure 2 shows the location of the wall motion abnormalities.
A hyperintensity in the same segments can be observed in T2-weighted imaging. Figure 3 shows the location of the hyperintense regions.
Figure 4 shows the delayed enhancement images of the patient. A transmural enhancement affecting the medial inferior and inferoseptal wall can be demonstrated.
Cine vs. T2 vs. Late-enhancement
Figure 5 shows the comparison between cine imaging, T2 weighted imaging, and delayed enhancement imaging.
In conclusion, the patient has wall motion abnormalities in the inferoseptal and inferior segments, together with myocardial edema, and transmural delayed enhancement in the same segments. The left ventricle function at rest is normal.