Provocation of microvessel spasm by low-dose acetylcholine in patients with suspected coronary artery disease--two case reports |
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Authors: | Masaki Nobuyuki Takase Bonpei Satomura Kimio Akima Takashi Matsushima Yoshihiro Hosaka Haruhiko Hamabe Akira Kurita Akira Ohsuzu Fumitaka |
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Institution: | The First Department of Internal Medicine, National Defense Medical College, Saitama, Japan. |
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Abstract: | Endothelial dysfunction plays an important role in the pathogenesis of cardiac syndrome X, and intracoronary low-dose acetylcholine infusion is a widely used diagnostic modality for studying the coronary artery endothelial function. The authors herein report 2 cases of cardiac syndrome X with coronary artery endothelial dysfunction and microvessel spasm. The findings of non-invasive testing were positive for ischemia. Coronary angiograms appeared entirely normal in both cases. However, the intracoronary infusion of low-dose (1.5-15 microg/minute) acetylcholine demonstrated an impairment of the coronary blood flow response and consequently provoked an ST-segment elevation in an electrocardiogram. The coronary angiograms showed no spasm in the epicardial arteries. These patients are thus suggested to have cardiac syndrome X with microvessel spasms associated with coronary artery endothelial dysfunction. |
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