Key result
Acetylcholine provocation testing with simultaneous right heart catheterization successfully diagnosed severe coronary artery spasm as the primary cause of repeated acute heart failure and transient pulmonary edema.
Case Report (n=1)
No
Coronary spasm should be considered in the differential diagnosis for repeated acute heart failure, and acetylcholine provocation testing with right heart catheterization can aid in diagnosis.
Answers are grounded in this paper and cite their sources.
Coronary spasm may underlie recurrent acute HF; leaves open whether acetylcholine provocation with catheterization aids diagnosis in unexplained cases.
Coronary spasm is abnormal contraction of an epicardial coronary artery resulting in myocardial ischemia. Coronary spasm induces not only depressed myocardial contractility, but also incomplete myocardial relaxation, which leads to elevated ventricular filling pressure. We herein report the case of a 55-year-old woman who had repeated acute heart failure caused by coronary spasm. Acetylcholine provocation test with simultaneous right heart catheterization was useful for the diagnosis of elevated ventricular filling pressure as well as coronary artery spasm. We should add coronary spasm to a differential diagnosis for repeated acute heart failure.
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Adachi et al. (2017) conducted a case report in Acute heart failure triggered by coronary spasm (n=1). Acetylcholine provocation test with simultaneous right heart catheterization was evaluated on Diagnosis of elevated ventricular filling pressure and coronary artery spasm. Acetylcholine provocation testing with simultaneous right heart catheterization successfully diagnosed severe coronary artery spasm as the primary cause of repeated acute heart failure and transient pulmonary edema.
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