Not Your Usual Ventriculogram | Patient Case Quiz

An 80-year-old Caucasian man with a history of hypertension presented with syncope. An electrocardiograph (ECG) demonstrated third-degree atrioventricular (AV) block and a non-contrast transthoracic echocardiogram showed a left ventricular (LV) ejection fraction of 35% with severe hypokinesis of the LV apex. A dual-chamber pacemaker was implanted. For further evaluation of his decreased ejection fraction, a nuclear perfusion study was performed that showed a small fixed perfusion defect in the inferior wall, although a diaphragmatic artifact could not be ruled out. Cardiac catheterization was subsequently performed to evaluate for ischemic heart disease. There was no evidence of obstructive coronary disease, and left ventriculography was performed as shown (Figure 1, Video 1).

Figure 1

Figure 1

Video 1

Which of the following statements explains these findings?

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