Anterior MI severe LVSD “+ something extra”

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Anterior MI severe LVSD “+ something extra” Mrs Rosemary Ashman (Walsall Manor Hospital) – Presentation for BSE image library Acknowledgement to UHNM – Stoke. Images obtained by JKA

Parasternal imaging was poor quality, but identifies congested LV, septal acontractility and thinning. Mild RV dilation.

Uncomplicated Appearance: Extensive LAD territory RWMA. (arising from proximal basal anterior septum extending laterally into neighbouring inferior septum, distal through mid to apical levels and traversing the apex/apical cap to involve all distal apical regions). Compensatory hyperdynamism of Basal to proximal mid: inferior inferior lateral wall (posterior) anterior lateral wall (lateral)

Lack of endocardial definition in arrowed areas would favour the use of LVO to directly visualise regional wall motion. Indirectly it is reasonable to deduce the “absent” segments are at least: thinned, acontractile, and akinetic (based on the surrounding visible adjacent segments). LVO may offer little additional value to regional analysis.

The importance of sliding medially to explore the RV apex cannot be underestimated, and in this case reveals RV apical thrombus.

Low parasternal close to Xiphoid process and subcostal assist in showing RV apical involvement.

Time can be against comprehensive scans but somethings are worth exploring further. With thanks to all contributors.