P34 TAKOTSUBO SYNDROME OR UNKNOWN MYOCARDIAL ISCHEMIA? THE ROLE OF CARDIAC MAGNETIC RESONANCE IN DIFFERENTIAL DIAGNOSIS

Abstract There are numerous clinical conditions in which symptoms and signs may overlap, among these myocardial Ischemia the absence of obstructive coronaropathy (INOCA/MINOCA), gets into differential diagnosis with a plethora pictures such as Takotsubo syndrome, myocarditis cardiomyopathies. In this setting, cardiac magnetic resonance has critical discriminating role. Herein we report case 52–year old patient suffering from hypertension dyslipidaemia, history chest pain episodes recent intense psychophysical stress. After exacerbation, ambulance was called, loss conscience witnessed, observing ventricular fibrillation, subjected to prompt DC shock. Once Emergency room, ECG showed ST–elevation V1, V2 AVR for urgent coronary angiography performed. It surprisingly resulted negative epicardial artery disease. Moderate left dysfunction (LVEF 45%) found on 2D ultrasound along apex akinesia, while mild elevation necrosis enzymes seen at blood tests. The picture characterized by female sex, stress, association pain, ischemic type alterations repolarization ECG, akinesia concomitant slight lesions, highly suggested Tako–Tsubo Syndrome. order confirm diagnosis, MRI performed which, unexpectedly, presence oedema T2–weighted STIR sequences level apex, associated same site transmural fibrosis post–contrast imaging sequences, thus eliciting hypothesis MINOCA. new retrosternal transient IVUS – guided examination performed, resulting intoIVA diffuse spasm, reduced after intravenous nitrate administration. Final “MINOCA complicated primary VF‘‘ subcutaneous AICD implant CMR virtue its ability provide information about structure function simultaneously, define characterization tissues, together data dynamic proved be essential establish often misunderstood, MINOCA, hence allowing best therapeutic strategy. ​