title: Acetylcholine-induced coronary spasm with a history of Kawasaki disease: case report.
abstract: A 21-year-old woman without any known coronary risk factors was found at coronary catheterization to have normal coronary angiograms, but demonstrated acethylcholine (ACh)-induced coronary spasm. She had a history of Kawasaki disease (KD) at 19 months of age and, although coronary angiography was not performed at that time, no coronary aneurysms were detected by echocardiography. To the best of our knowledge, this is the first case report of ACh-induced coronary spasm associated with normal coronary angiograms in a young person with a history of KD. The findings suggest that subclinical, persistent coronary endothelial dysfunction may exist in this patient; furthermore, the dysfunction appears diffuse and might be unrelated to coronary aneurysm formation. The long-term significance of coronary endothelial dysfunction in patients with KD, as suspected by coronary spasm, remains unknown but may be an important risk factor for future atherosclerosis.
authors.affiliation: Division of Cardiology, Cardiovascular Center, Teine Keijinkai Hospital, Sapporo, Japan. dfwnoris@aol.com
authors.forename: Hironori
authors.initials: H
authors.lastname: Murakami
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Hirokami
authors.forename: Nagisa
authors.initials: N
authors.lastname: Hanawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oomoto
authors.forename: Yasukazu
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Kenjirou
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Takizawa
authors.forename: Tamaki
authors.initials: T
authors.lastname: Takada
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Togashi
authors.forename: Shigemichi
authors.initials: S
authors.lastname: Tanaka
mesh_terms: D000109:Acetylcholine / Q000494:pharmacology*; D000328:Adult; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000139:chemically induced*; D004730:Endothelium, Vascular / Q000473:pathology; D005260:Female; D006801:Humans; D009080:Mucocutaneous Lymph Node Syndrome / Q000503:physiopathology*
chemical_list: D000109:Acetylcholine