Acute anteroseptal myocardial infarction

Case contributed by Dr David Cuevas

Presentation

Acute chest pain with positive biomarkers for myocardial infarction.

Patient Data

Age: 40 years
Gender: Male

Function and morphology

MRI

Severe anterior and anteroseptal septal hypokinesia.

Pericardial effusion.  

Tissue characterization (no contrast)

MRI

T2 weighted images show extensive septal and anterior myocardial edema.

Gradient echo image depicts a dark anteroseptal and anterior wall rim consistent with myocardial hemorrhage.

DWI, optional/experimental use in myocardial infarction, shows both findings. 

Perfusion and viability module (Gadolinium first pass and LGE)

MRI

First pass or perfusion images: subendocardial perfusion defect (absence of signal, dark or black) in LAD territory.

Late gadolinium enhancement: depicts transmural infarction (transmural hyperintensity, bright or white), also shows "no-reflow" phenomenon (an endocardial rim of absent signal even in LGE images).

Revascularization has a poor outcome in transmural infarction (considered non-viable tissue) and the presence of the "no-reflow" phenomenon has a poor prognosis.

DSA (angiography)

There is severe stenosis of the proximal left anterior descending coronary artery (LAD) and total occlusion at the mid LAD. 

Case Discussion

Typical CMR findings in acute myocardial infarction.

A percutaneous coronary intervention performed first was unable to deploy a coronary stent, CMR is used to assess the extent of the disease and prognosis prior to revascularization surgery. Currently, CMR has similar to higher sensitivity compared to SPECT to assess myocardial viability.

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