Late-Onset Arrhythmogenic Right Ventricular Cardiomyopathy Mimicking Acute Coronary Syndrome in an Elderly Female: A Case Report.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a cardiac condition characterized by the replacement of myocardial tissue with fibrofatty tissue, primarily affecting the right ventricle. Though typically presenting in younger individuals, this case report discusses a rare presentation in a 72-year-old female who exhibited symptoms mimicking acute coronary syndrome (ACS), including chest pain and sustained ventricular tachycardia (VT). Coronary angiography revealed normal coronary anatomy, ruling out ACS as the underlying cause. Cardiac MRI demonstrated structural abnormalities in the right ventricle, consistent with ARVC. Genetic testing confirmed a pathogenic mutation in the PKP2 gene. The patient was treated with antiarrhythmic medications and received an implantable cardioverter-defibrillator (ICD) for secondary prevention of sudden cardiac death. This report emphasizes the importance of considering ARVC in the differential diagnosis of elderly patients with unexplained ventricular arrhythmias and chest pain, particularly when coronary angiographic findings are normal.