Background:
Arrhythmogenic cardiomyopathy (ACM) is an inherited condition. It is sub-characterized into arrhythmogenic right, left, and bi- ventricular cardiomyopathies. The Padua task force criteria is used in the diagnosis of ACM.

Case report:
A 41-year-old presented with palpitations was found to be in ventricular tachycardia. He was reverted back into sinus rhythm following cardioversion. Electrocardiogram showed widespread T-wave inversions. Initial troponin was raised with unobstructed coronaries on coronary angiogram. Transthoracic echocardiogram (TTE) seven months prior showed reduced left ventricular systolic function (LVSD) with unremarkable right ventricular (RV) function. TTE on this admission showed new right sided failure with worsening LVSD. Cardiac magnetic resonance imaging (MRI) appearance was consistent with biventricular ACM based on morpho-functional criteria.

Discussion:
This case highlights how RV function can decline rapidly in ACM. Widespread T-wave inversion is a minor criterion in the task force criteria. If TTE is indicative of underlying cardiomyopathy, cardiac MRI is the gold-standard investigation to confirm the pathology.