1. 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

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

3. 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)

4. 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.

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

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

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