Number 09-01: Is it or isn’t it coronary artery disease?
Share |

Number 09-01: Is it or isn’t it coronary artery disease?

Case from: Anna Herrey, Ajay Suri, Andrew Flett, Simon Woldman, The Heart Hospital, London, UK

History: A 46-year-old man presents with breathlessness, heart failure and chest pain. Troponin borderline

Past medical history: Diffuse coronary artery disease 3 year previously; systemic lupus with persistent pleural effusion and joint pains.

Echo: globally poor systolic function, borderline AV dyssynchrony SPECT: ‘minimal inducible ischaemia’

Angiography: delayed as too unwell.

CMR requested, question: ischaemic cardiomyopathy?



* note: cine artefact was determined to be due to the surface coil connection

Cine CMR: Marked dilatation and regional dysfunction* (inferior and infero-lateral dyskinesis with preserved myocardial thickness)

Contrast CMR: absence of LGE suggests viability of all territories CMR diagnosis: Likely stunning of infero-septal and inferior wall. Consider angio. The possibility of thrombus in a dominant RCA exists…



Coronary angiography: A dominant RCA with thrombus – treated with successful PCI

Follow-up CMR: six weeks later: significant regional and global LV recovery (+20% ef) confirming stunning of the inferior and infero-septal wall. No infarction from the procedure





Conclusion: CMR accurately predicted the presence of acute coronary disease as well as recoverability of the affected coronary territories.

Mailing Address
19 Mantua Rd
Mt. Royal, NJ 08061
Contact Us
Connect With Us