661 TWO CARDIOMYOPATHIES IN ONE HEART: LESSONS FROM CLINICAL CASE

Abstract Case description In November 2020, a 55-years-old female with no significant past medical history, was admitted to our Emergency Department for chest pain after acute stressful event. She had family history of ischemic heart disease, and unclear comatose status her sister. At admission, she asymptomatic, blood pressure 115/80 mmHg, oxygen saturation 96%. An electrocardiogram (ECG) showed biphasic T wave in anterolateral leads. Elevated levels troponin I (hs-TnI 900 ng/L) B-type natriuretic peptide (BNP) 864 pg/mL were detected. Transthoracic echocardiogram (TTE) revealed an ejection fraction (EF) 30% apical ballooning mid segments the left ventricle (LV) along sizable thrombus. Aspirin, iv diuretics, nitrates unfractioned heparin started. After 13 hours, suffered sudden transient neurological sign decreased level consciousness. Cranial MRI lesion territory apex basilar artery (thalamic region). 7 days from stroke, patients underwent coronary angiography demonstrating unobstructed coronaries. Thus, diagnosis takotsubo syndrome confirmed. During hospitalization, ECG evolution inversion precordial lateral Hs-TnI declining within normal values. Of note, ventricular arrhythmias burden polymorphic contraction (PVC) emerged on continuous ECG-monitoring. Despite resolution balloning thrombosis, there persistent wall-motion abnormalities infero-lateral walls mild LV dysfunction. This also confirmed by cardiac magnetic resonance (CMR). Further, CMR intense myocardial edema elevated mass. The discharged Warfarin, Bisoprolol 2.5 mg/die, Ramipril 5 Eplerenone 25 mg/die. A clinical documentation required further investigate sister, sequelae arrest at 28s related fibrillation emerged. However, deeply evaluation underlining disease available. early favorable follow-up patient, six months, palpitations failure requiring diuretic therapy. Persistent repolarization leads, low-voltage leads noted. extensive moderate dysfunction Importantly, arrhythmic PVC (13%) 24-hr monitoring recorded. requested possibility coexisting cardiomyopathy. Mild dilation, (LVEF 39%), wall motion thinning inferior middle reported. Surprisingly, fibro-fatty replacement detected, unexpectedly, right (RV) RV described. Hence, arrhythmogenic cardiomyopathy made. Since despite optimized treatment, biventricular involvement, SCD, implantable cardioverter defibrillator primary prevention placed. Furthermore, genetic testing screening suggested. Conclusion According data collected, arrhytmogenic can coexist. potential link between two may be identified future, especially among presenting long-term unfavorable outcome.