title: Insulin resistance relates to acetylcholine-induced microvascular vasoconstriction in a patient with vasospastic angina: potential implication of causalities between hyperinsulinemia and coronary microcirculation failure.
abstract: Coronary vasomotor response to acetylcholine infusion was studied in a 69-year-old currently smoking man with enhanced insulin response to oral glucose load. Coronary angiogram showed no significant stenoses. Immediately after 20 microg acetylcholine infusion in the right coronary artery, angiographic no-flow, ischemic electrocardiographic changes, and anginal pain developed in the absence of epicardial coronary obstruction. While intracoronary infusion of isosorbide dinitrate was only partially effective, intracoronary infusion of nicorandil, an agent known to improve coronary microcirculation, completely resolved these changes. This is the first case reported so far suggesting that enhanced insulin response may be associated with acetylcholine-induced microvascular vasoconstriction. Microvascular vasoconstriction must be considered when a patient with insulin resistance presents with chest pain.
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Naotsugu
authors.initials: N
authors.lastname: Oyama
authors.forename: Kazushi
authors.initials: K
authors.lastname: Urasawa
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Sakai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fujii
authors.forename: Akira
authors.initials: A
authors.lastname: Kitabatake
mesh_terms: D000109:Acetylcholine / Q000008:administration & dosage; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D003329:Coronary Vasospasm / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D004562:Electrocardiography; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications / Q000503:physiopathology*; D007261:Infusions, Intra-Arterial; D007333:Insulin Resistance; D007548:Isosorbide Dinitrate / Q000008:administration & dosage; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D020108:Nicorandil / Q000008:administration & dosage; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D020108:Nicorandil; D007548:Isosorbide Dinitrate; D000109:Acetylcholine