Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 11 4 2017 02 11 192 194 EN Farveh Vakilian Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mahmood Mohamadzadeh Shabestari Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Ahmad Amin Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Soheila Chamanian Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Toktam Moghiman Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2017 01 07 2017 01 07 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. https://rhythm.tums.ac.ir/index.php/jthc/article/view/649 https://rhythm.tums.ac.ir/index.php/jthc/article/download/649/515