A 22 year old male attended primary care (PC) with a personal history of functional murmur in childhood, seasonal allergic rhinitis, smoker of 10 cigarettes a day and weekend drinker. Family history of no interest. After performing an ECG at the primary care clinic prior to travelling abroad to study at a private university in the United Kingdom, a generalised negative T wave was observed from V2 to V6 and in the inferior face, with isolated ventricular extrasystoles. Physical examination revealed blood pressure of 140/70 mm Hg, normal cardiopulmonary auscultation at 60 beats per minute with no other data of interest. With these electrocardiographic findings, he was referred to the cardiology department.

The complementary studies requested from the PC were normal (blood tests with haemogram, biochemistry and coagulation; lateral and posteroanterior chest X-ray). The echocardiogram showed significant dilatation of the right ventricle (55 mm), with a hypokinetic lateral face and mild tricuspid insufficiency. The holter monitor shows sinus rhythm and migratory atrial pacing with frequent ventricular extrasystoles and some ventricular triplets. Cardiac MRI shows an enlarged right ventricle with moderator band hypertrophy with thin wall with some hyperintense areas within it suggestive of fatty infiltration, with small dyskinetic sacculations. The left ventricle, valves and pericardium are normal.
With the suspected diagnosis of ARVC, treatment with beta-blockers was started. The patient remained asymptomatic and underwent regular check-ups. Upon his return to Spain two years later, after playing a basketball game, he developed syncopal symptoms and it was finally decided to have an ICD implanted. One month after admission, he was referred to the Rehabilitation Service to assess the possibility of starting a Cardiac Rehabilitation Programme (CRP). The patient continues to lead an active life today, one year later, with follow-up from Primary Care and check-ups by Cardiology.