dissection flap nor aortic regurgitation was detected. Coronary angi- ography was performed thereafter with prediagnosis of acute anterior wall MI based on electrocardiographic findings. Results: No significant luminal narrowing was detected at left cor- onary artery system. However, right coronary angiography revealed coronary dissection from ostium to mid nondominant RCA (Figure 1). Also some proximal ascending aorta staining was noticed after selective dye injection of right coronary ostium. In order to exclude aortic dissection, thoracic computed tomography was performed and revealed chronic small aortic dissection in the arcus aorta but not in the coronary sinus level. A bare metal stent extending from right coronary ostia to mid RCA was deployed with a resulting TIMI III flow and resolution of dissection post-procedure. Chest pain subsided and electrocardiogram returned to normal. Transthoracic echocardiograpy revelaed lateral wall hypokinesis of right ventricle with conservation of right ventricular apex. Conclusions: Conditions that have been shown to predispose SCAD are: Marfan syndrome, pregnancy and peripartum state, drug abuse, anatomical abnormalities of the coronary arteries and several autoim- mune disorders. SCAD might result in acute coronary syndromes or can be found incidentally during coronary angiography. In our patient, SCAD resulted in isolated acute right ventricular MI, which mimicked acute anterior MI electrocardiographically. This case also emphasizes the value of invasive coronary imaging. Since with only an electro- cardiographic evaluation, thrombolytic therapy could have been given despite the absence of complete occlusive thrombus. - PP-042 Reasinabilty of Urine Toxicology Screening for Cocaine in Younger Patients with Acute Coronary Snydrome. Ender Örnek 1 , Candan Mansuroglu 1 , Mustafa Cetin 1 , Burcu Ugurlu 1 , Emrullah Kızıltunç 1 , Harun Kundi 1 , Ahmet Balun 1 , Murat Gök 1 , Dils ¸en Ornek 1 , Alpaslan Kurtul 2 , Vasfi Feridun Ulusoy 1 . 1 Ankara Numune Research and Education Hospital; 2 Ankara E gitim ve Aras ¸tırma Hastanesi. Introduction: Cocain is one of the most commonly used illicit drug which can cause myocardial ischemia or infarction. Cocaine use can cause acute coronary syndrome by inducing coronary vasoconstriction, thrombosis, dissection, positive sympathomimetic effects and direct myocardial toxicity. Recent American guidelines recommend to do urine toxicology screening for cocaine when substance abuse is sus- pected as a cause of or contributor to acute coronary syndrome, espe- cially in younger patients. This study was aimed to investigate the reasonability of urine toxicology screening for cocaine in consecutive younger patients with acute coronary syndrome in Turkey. Material and methods: Twenty patients younger than 50 years of age who admitted to coronary care unit with acute coronary syndrome were consecutively enrolled to the study. Mean age was 426 ( range 38-50 ). Male to female ratio was 5/12. Acute myocardial infarction with ST-segment elevation was diagnosed in 6 patients and acute coronary syndrome without persistent ST-segment elevation was diagnosed in 7 patients.. Urine samples of all patients were analyzed for cocaine. Results: Clinical characteristics of the patients are shown in Table 1. Urine sample analysis for cocaine were negative in all patients in the range of 0-30 ng/dl. - PP-043 An Atypical Localization of Takotsubo Cardiomyopathy. Özgül Uçar Elalmıs ¸ , Havva Tu gba Gürsoy, Mehmet Ileri, Deniz S ¸ahin, Muhammet Cihat Çelik, Ümit Güray. Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey. Objective: Takotsubo cardiomyopathy (TCM) is characterized by tran- sient hypokinesis of the left ventricular apex, and is associated with emotional and physical stress. Wall motion abnormality is typically seen in left ventricular (LV) apex, however atypical localizations can be seen. Here, we present a case of TCM with mid-ventricular wall balooning. Methods: A 52-year-old woman presented with chest pain and syncope, following emotional stress due to death of her husband. On ECG, the rhythm was sinusal. There were slight ST segment elevation in leads V1-V3 and T wave inversion in leads V1-V3, aVL. Prominent U waves and sinusal bradycardia were also present. At admission, CK- MB was 27 U/L, total CK: 312 U/L, troponin I: 0.47 ng/ml (N: 0-0.15). She had smoking and early menapause as coronary risk factors. Blood biochemistry was unremarkable except mild hypokalemia. Haemogram was normal. Results: The following day, coronary angiography and left ven- triculography were performed with the diagnosis of acute coronary syndrome. There were fibrofatty atherosclerotic plaques in all three epicardial coronary arteries. Left ventriculography revealed mid-ante- rolateral ballooning with sparing of the apex and other left ventricular segments (Figure 1). Transthoracic echocardiography demonstrated mid-anterolateral wall dyskinesis with a global ejection fraction of 55%. During follow-up troponin I levels were 0.44 ng/ml and 0.08 ng/ml, respectively. The patient was discharged with optimal medical therapy. At one month control, echocardiography returned to normal with no wall motion abnormality. The ECG was also normal with mild sinusal bradycardia. Our diagnosis was an atypical variant of TCM with mid- ventricular involvement. Figure. Coronary angiogram reveals right coronary artery dissection. Table The clinical characteristics of the study population (n: 25) Age ( years ) 46,23( 37- 48) STEMI/NSTEMI(%) 47,35 Male gender (n,% ) 89,12 Heart rate ( min.  1 ) 72,24 Systolic BP ( mmHg ) 123,27 Diastolic BP ( mmHg ) 78,89 Hypertension ( % ) 45,23 Family history ( % ) 37,34 Diabetes mellitus ( %) 23,34 Smoking ( % ) 43,35 Total cholesterol ( mg/dl ) 218,34 LDL cholesterol ( mg/dl ) 142,23 HDL cholesterol ( mg/dl ) 48,34 Trigliceride ( mg/dl ) 205,45 MARCH 26e29, 2015 S116 The American Journal of Cardiology â MARCH 26e29, 2015 11 th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster P O S T E R A B S T R A C T S