Surreal illustration symbolizing the connection between ARVC and microvascular disease.

Uncommon Heart Condition Linked: Is There a Connection Between ARVC and Cardiac Microvascular Disease?

Nico Varela in Health & Wellness December 2025 • 4 min read.

"Exploring a Rare Case Study: Could Arrhythmogenic Right Ventricular Cardiomyopathy Be Associated with Cardiac Microvascular Disease?"

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a heart condition marked by irregular heart rhythms and an increased risk of sudden cardiac arrest. It happens when the heart muscle is replaced by fatty or fibrous tissue, especially in the right ventricle. This can lead to life-threatening arrhythmias and heart dysfunction. While ARVC is well-recognized, its less common associations with other heart conditions are still being explored.

One such area of interest is the potential connection between ARVC and cardiac microvascular disease (MVD). Cardiac MVD involves the small blood vessels of the heart, leading to reduced blood flow and possible ischemia (reduced oxygen supply to the heart muscle). While MVD is often linked to conditions like diabetes and hypertension, its occurrence in ARVC patients raises questions about shared underlying mechanisms or risk factors.

This article delves into a fascinating case study that explores the intersection of ARVC and cardiac MVD. By examining the details of this rare co-occurrence, we aim to shed light on possible links, diagnostic considerations, and potential implications for managing patients with these complex heart conditions.

The Case: ARVC and Microvascular Disease

Surreal illustration symbolizing the connection between ARVC and microvascular disease.

The study, published in the Journal of Cardiovascular Medicine in 2017, detailed the case of a 59-year-old woman with a history of angina. Initial evaluations in 1999 revealed that while her physical examination and standard ECG were normal, she had some concerning signs. An echocardiogram showed dilation and reduced ejection fraction in her right ventricle, though the left ventricle appeared unaffected.

Further tests provided a clearer picture:

Holter Monitoring: Recorded episodes of chest pain with transient ST-T segment depression, but no ventricular arrhythmias.
Treadmill Stress Test: Chest pain developed during exercise, accompanied by ST-T segment depression in precordial leads.
Cardiac MRI: Confirmed fibro-fatty replacement of the myocardium and right-chamber enlargement, pointing towards ARVC.
Coronary Angiography: Showed normal coronary arteries, ruling out major blockages. However, an invasive coronary flow reserve study indicated increased coronary flow resistance.
Endomyocardial Biopsies: Revealed fibro-fatty tissue replacement in both the right and left ventricles.

Following these findings, the patient was diagnosed and treated with medications, including verapamil, an ACE inhibitor, and a statin. Over the next 12 years, her condition was closely monitored. While echocardiograms showed a gradual enlargement of the right ventricle, she remained free of significant left ventricular dysfunction or ventricular arrhythmias. She did, however, continue to experience angina-like chest pain, with stress tests consistently indicating myocardial ischemia.

What Does This Mean for ARVC Patients?

This case suggests a possible link between ARVC and cardiac microvascular disease. While the exact nature of the connection remains unclear, the study authors propose that the histological changes associated with ARVC, such as thickening of the distal coronary vessels, might contribute to microvascular dysfunction. Further research is needed to confirm this association and explore its implications for risk stratification, clinical management, and the use of ICDs (implantable cardioverter-defibrillators) in ARVC patients.

About this Article -

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Everything You Need To Know

What is Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), and how does it affect the heart?

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a heart condition where the heart muscle, particularly in the right ventricle, is replaced by fatty or fibrous tissue. This structural change can disrupt the heart's electrical signals, leading to irregular heart rhythms and an increased risk of sudden cardiac arrest. The dysfunction can cause life-threatening arrhythmias and affect the heart's ability to pump blood effectively.

How does Cardiac Microvascular Disease (MVD) impact heart health, and what is its connection to ARVC?

Cardiac Microvascular Disease (MVD) involves the small blood vessels of the heart, leading to reduced blood flow and potential ischemia, which is a reduced oxygen supply to the heart muscle. The connection to Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is being explored because MVD is not typically associated with ARVC. The occurrence of MVD in ARVC patients raises questions about shared underlying mechanisms or risk factors, suggesting a possible link that warrants further investigation and clinical management.

What were the key findings in the case study regarding the 59-year-old woman's diagnosis of ARVC and possible cardiac MVD?

The case study of the 59-year-old woman revealed several key findings. Initial assessments showed concerning signs, including dilation and reduced ejection fraction in her right ventricle. Further tests, such as Holter monitoring, treadmill stress tests, and cardiac MRI, confirmed Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). Coronary angiography ruled out major blockages, but an invasive coronary flow reserve study indicated increased coronary flow resistance, pointing towards Cardiac Microvascular Disease (MVD). Endomyocardial biopsies revealed fibro-fatty tissue replacement in both ventricles.

How did the patient's treatment and monitoring evolve over the 12 years following the diagnosis, and what were the outcomes?

Following the diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) and the likely presence of Cardiac Microvascular Disease (MVD), the patient was treated with medications, including verapamil, an ACE inhibitor, and a statin. Over the next 12 years, her condition was closely monitored. Echocardiograms showed a gradual enlargement of the right ventricle, but she remained free of significant left ventricular dysfunction or ventricular arrhythmias. She continued to experience angina-like chest pain, with stress tests consistently indicating myocardial ischemia, suggesting ongoing microvascular issues despite treatment.

What implications does this case study have for patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), and what further research is needed?

This case study suggests a possible link between Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) and Cardiac Microvascular Disease (MVD). The study's authors propose that the histological changes associated with ARVC might contribute to microvascular dysfunction. Further research is needed to confirm this association and explore its implications for risk stratification, clinical management, and the use of ICDs (implantable cardioverter-defibrillators) in ARVC patients. Understanding this connection could lead to improved diagnostic approaches and more effective treatments for patients with these complex heart conditions.