308 THE BROKEN HEART: A LEFT VENTRICLE FREE WALL RUPTURE IN MINOCA

Abstract 86 years-old man was admitted to our ICCU for chest pain with an ECG diagnosis of atrial fibrillation and inferior STEMI. He had a history hypertension ascending aorta aneurysm (48 mm) no other known cardiovascular risk factor. reported few episodes short-duration in the last days. A fast echocardiogram excluded dissection pericardial effusion but showed hypokinesia inferolateral left ventricle wall. Urgent angiography only revealed moderate stenosis on mid anterior descending artery associated slow run-off. No lesions were found expected culprit artery. Due persisting patient's aneurysm, urgent Angio CT performed, unexpectedly, during exam, patient lost consciousness asistolia. RCP practised ROSC. scan mild blushing. free wall heart rupture suspected by radiologist. suggestive colour doppler systolic flow originating from apparent hole apical Rapid hemodynamic failure occurred so pericardiocentesis amine support blood transfusions performed. Heart team surgery due extremely high operative related age, impairment poor repair durability consequent acute phase rupture. observation made, liable stability obtained norepinephrine infusion. In accordance family invasive measurements not taken. Unfortunately, died day after. Only cases myocardial infarction-non obstructive coronary disease (MINOCA) are literature. Recurrent makes plaque complication/embolus resolution reliable hypothesis. New onset might have caused embolization determining transmural ischaemia, as well rupture/ulceration done. further exams exploit underneath pathological process could be performed: Coronary intravascular ultrasound, optical coherence tomography, Cardiac Magnetic resonance would valid help prognosis future treatment.