Arrhythmogenic Right Ventricular Dysplasia

Arrhythmogenic right ventricular dysplasia (or ARVD) is a disease of the heart muscle. In this disease, fatty fibrous tissue replaces normal heart muscle. This interrupts normal electrical signals in the heart and may cause irregular and potentially life-threatening heart rhythms. The heart also becomes weaker over time leading to heart failure.

ARVD typically begins in a small part of the right ventricle. Over time, the disease slowly affects more of the right ventricle. Sometimes the left ventricle is affected, too. This can lead to abnormal heart rhythms, and sometimes sudden death. Over time, the heart can’t pump as much blood forward as it normally would. Blood backs up in the circulatory system causing fluid to build up in the soft tissues or the lungs. This can lead to many symptoms such as swelling (edema) and shortness of breath.

ARVD is a fairly rare genetic disease. It usually starts between the ages of 10 and 50 years old. The severity of the disease varies a great deal between people.

ARVD results from a genetic defect. Genes are part of your DNA, the material passed down from parents to children. This genetic defect leads to the the replacement of normal heart tissue with fatty or fibrous tissue. How this happens is not yet clear.

Most cases of ARVD are autosomal dominant. This means you need an abnormal gene from only one of your parents to have it. Still, even if you have an abnormal gene, you might not develop any major symptoms from ARVD. Researchers are still trying to understand what other factors may increase disease severity.

Having a relative with ARVD puts you at risk for the disease. A parent with an abnormal gene has a 50% chance of giving that gene to his or her child. If someone in your family has ARVD, you may be able to use genetic testing to see whether you are at risk. Anyone with an abnormal gene should see a doctor for regular monitoring.

Symptoms of ARVD tend to get worse over time as the disease affects more of the heart. Some people with ARVD show no symptoms. And others may have more severe symptoms. These may include:

• Fainting
• Heart palpitations with unpleasant awareness of the heartbeat
• Dizziness
• Shortness of breath with exertion
• Shortness of breath when lying down
• Chest pain
• Fatigue
• Swelling in the legs and other areas
• Persistent cough
• Sudden death due to an abnormal heart rhythm

Heart palpitations and fainting are common early symptoms. Unfortunately, sudden death is also sometimes the first symptom of ARVD. The other symptoms tend to come on more gradually.

ARVD can be hard to diagnose. Family history and a clinical exam sometimes give some clues. A cardiologist usually needs multiple tests to come up with a diagnosis. These may include:

• Electrocardiogram (ECG), to analyze the heart rhythm
• Continuous portable ECG monitoring, to check heart rhythms away from the doctor’s office
• Signal-averaged ECG, to assess the potential for irregular heart rhythms
• Echocardiogram, to examine blood flow in the heart and heart motion
• Exercise ECG testing, to evaluate the heart rhythm during physical exertion
• Cardiac MRI, to further examine heart anatomy and heart wall motion
• Angiography, with catheterization, to visualize vessels in the heart
• Heart biopsy, to examine the heart in more detail
• Electrophysiology study, to further analyze the heart rhythm

Genetic testing can confirm the diagnosis, but usually this is not necessary.

There are a variety of medicine to help treat ARVD. Some of these may only be needed when the disease is more severe. They include:

• Medicines to control your heartbeat and rhythms, such as beta-blockers
• Medicines to help prevent abnormal heart rhythms (antiarrhythmics)
• Diuretics (water pills) to reduce swelling (edema)
• Medicines to reduce the workload of the heart, like ACE inhibitors
• Anticoagulants (blood thinners) to prevent blood clots

Catheter ablation is another option for certain people with abnormal heart rhythms and ARVD. This is a procedure used to treat certain types of abnormal heart rhythms. Ablation involves threading a catheter through a vein in the groin up to the heart. There, the doctor sends heat to destroy the cells that are starting abnormal heartbeats.

Many people with ARVD need an implantable cardioverter defibrillator (ICD). An ICD uses electrical shocks to treat life-threatening arrhythmias. This can help prevent sudden death. Your doctor will analyze your symptoms and test results to determine whether you need an ICD.

Rarely, you may need heart transplant if the damage to your heart has become severe.

Your doctor may give you additional instructions about how to manage your ARVD.

• Your doctor may tell you to limit heavy physical activity.
• Your doctor may want to treat you for other heart conditions. This might include cholesterol-lowering medicine.
• You might need other lifestyle changes, such as losing weight, quitting smoking, or improving your diet. You may need to restrict salt in your diet.
• You may need to reduce the amount of alcohol or caffeine in your diet. (These can increase the risk of abnormal heart rhythms.)
• Monitor your symptoms carefully. If you are gaining weight quickly, it might be a sign of increased swelling due to poor heart function.

See a doctor right away if you have severe symptoms like chest pain, passing out, or severe shortness of breath. If your symptoms are gradually increasing, plan to see your doctor soon.

Arrhythmogenic right ventricular dysplasia is a genetic disease affecting the heart muscle, mainly in the right ventricle. It can cause abnormal heart rhythms, some of which can cause sudden death. It can also make the heart unable to pump enough blood.

• Follow your doctor’s instructions carefully. Take all your medicines as prescribed. Follow any exercise precautions given.
• If you have ARVD, or if you have a close relative with ARVD, see your doctor regularly for monitoring. This is important even if you don’t have any symptoms.
• Some people with ARVD may not require extensive treatment, especially if it is in the early stages. Some people do need medicines or procedures, though.
• Tell your doctor if you have symptoms or if your symptoms increase.
• Other family members may need to be tested for ARVD.

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.