Key result
Acetylcholine testing induced typical chest pain and ST segment elevation without epicardial coronary spasm, suggesting small-vessel vasospasm as a cause of myocardial ischemia.
Case Report (n=1)
This case report highlights that small-vessel vasospasm may be a mechanism for myocardial ischemia in patients with normal epicardial coronary arteries.
May support acetylcholine testing for microvascular spasm in ischemia with normal arteries; leaves open need for validation in prospective cohorts.
Small-vessel vasospasm has been speculated upon as a possible cause of chest pain in patients with normal-appearing coronary angiograms. In this report, a patient who experienced typical chest pain during acetylcholine testing, which caused ST segment elevation without epicardial coronary spasm, is presented. This finding suggests that small-vessel vasospasm may be involved in the induction of myocardial ischemia in patients with normal epicardial coronary arteries.
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Sekiya et al. (1993) conducted a case report in Chest pain with normal-appearing coronary angiograms (n=1). Acetylcholine testing was evaluated on ST segment elevation without epicardial coronary spasm. Acetylcholine testing induced typical chest pain and ST segment elevation without epicardial coronary spasm, suggesting small-vessel vasospasm as a cause of myocardial ischemia.
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