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RIGHT CORONARY ARTERY: This is a dominant vessel. There is a long segment of severe subtotal disease extending from the proximal portion to almost the mid third. The rest of this vessel also appears to be diffusely diseased. The posterior descending branch is identified and this is 80% narrowed at its ostium. There is another 90% lesion in the distal 1/3 of this vessel. The AV branch is diminutive. LEFT CORONARY ARTERY: Left main trunk is calcified and has a 60% distal narrowing. Left anterior descending is severely diseased from its origin, and gives off a diagonal and septal perforator and then the LAD is totally occluded. The circumflex calcification is seen in the main trunk where moderate plaque is seen compromising the lumen about 50% The circumflex then divides into two branches; the first is the lateral branch and then a second lateral branch. The first lateral branch is severely narrowed in its proximal portion to 90%,cheap coats and jackets for women, and then has another long segment of about 75% narrowing. This does appear to be a diffusely diseased vessel. The second lateral branch also has a long segment of 90% disease distally. The terminal AV branch of the circumflex is completely occluded. LEFT VENTRICLE: End systolic and end diastolic volumes are increased. There is diffuse impairment of contractility indicating diffuse multiwall ischemia. Overall contractility is mild to moderately impaired with an ejection fraction of the post PVC beat being around 40% or so. No major wall segment abnormalities are noted. The mitral and aortic valves are normal. The descending aorta is slightly dilated.
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