A case of coronary microvascular spasm with slow flow induced by the intracoronary acetylcholine provocation test.
Microvascular angina is a rare condition in which myocardial ischemia is caused by microvascular dysfunction without any abnormalities of the epicardial coronary arteries. In clinical practice, it is difficult to diagnose because the microvascular alterations cannot be detected by conventional angiography. Herein we present a rare case of a 67-year-old woman with unstable angina pectoris in whom considerably slow coronary flow was induced by the acetylcholine provocation test with mild epicardial arterial spasm, suggesting the presence of microvascular spasm. Moreover, we show that β-methyl-p-[(123)I]-iodophenyl-pentadecanoic ((123)I-BMIPP) single-photon emission computed tomography imaging is useful for proving myocardial ischemia.
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan. y-tanabe@muj.biglobe.ne.jp.
Yasuhiro
Y
Tanabe
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
Kihei
K
Yoneyama
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
Masaki
M
Izumo
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
Ken
K
Kongoji
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
Tomoo
T
Harada
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
Yoshihiro J
YJ
Akashi
D000109:Acetylcholine / Q000008:administration & dosage*; D000368:Aged; D003326:Coronary Circulation / Q000187:drug effects*; D003329:Coronary Vasospasm / Q000175:diagnosis* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008833:Microcirculation; D011859:Radiography; D012039:Regional Blood Flow / Q000502:physiology*; D014665:Vasodilator Agents / Q000008:administration & dosage
D014665:Vasodilator Agents; D000109:Acetylcholine
123I-BMIPP myocardial scintigraphy; Intracoronary acetylcholine provocation test; Microvascular angina; Slow flow