Evaluation of Coronary Arteries in Non-Ischemic Cardiomyopathies: A Case Report
Farveh Vakilian1, Mahmood Mohamadzadeh Shabestari1, Ahmad Amin2
1Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) can present with unexpected coronary artery issues. This case highlights a left anterior descending artery blockage in an ARVD/C patient, emphasizing the need to consider cardiac disease in heart failure management.
Area of Science:
- Cardiology
- Genetics
- Pathology
Background:
- Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a genetic heart muscle disease characterized by fibro-fatty replacement of the right ventricle.
- It is a significant cause of sudden cardiac death, particularly in younger individuals, often presenting with ventricular arrhythmias and heart failure.
Observation:
- This report details an incidental finding in a middle-aged male ARVD/C patient experiencing frequent heart failure decompensation.
- Despite no prior history of chest pain or coronary artery disease risk factors, a new coronary angiography revealed a critical blockage in the proximal left anterior descending artery.
Findings:
- The patient exhibited progressive left ventricular dysfunction, with ejection fraction dropping from 45-50% to 35-40% over two years.
- Percutaneous coronary intervention was successfully performed for the left anterior descending artery occlusion, with no other significant coronary lesions identified.
Implications:
- The study suggests that coronary artery disease should be considered in patients with ARVD/C and worsening heart failure, even without typical ischemic symptoms.
- This case underscores the importance of comprehensive cardiovascular evaluation, as coronary events may complicate the natural course of ARVD/C.
Abstract:
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a congenital cardiac disease with myocardial involvement, most probably right ventricular (RV) dysfunction, accounting for 20% of sudden cardiac deaths. Characterized by the fibro-fatty infiltration of the RV free wall, ARVD/C presents in adolescents with ventricular arrhythmias and heart failure symptoms and as biventricular failure in adults. The coronary risk in these patients is not clear. We present an incidental finding: the left anterior descending artery cut-off in a middle-aged man with ARVD/C. He had been under treatment for heart failure symptoms, which had decompensated frequently commencing 6 months earlier, and therefore he was scheduled for stem cell injection. He had no chest pain or coronary artery disease risk factors. Two-dimensional transthoracic echocardiography demonstrated RV enlargement with moderate to severe dysfunction and left ventricular ejection fraction (LVEF) of 35-40%, which was 45-50% two years before. Selective coronary angiography performed 8 years previously was normal but a new one revealed the cut-off of the left anterior descending artery at the proximal portion, for which percutaneous coronary intervention was performed and showed no significant lesion in the other vessels. One should consider coronary artery disease in uncontrolled heart failure with LVEF reduction, even in the absence of typical chest pain. It may not be the natural course of the underlying disease.
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