PMC5283960_01
ECG on admission. ECG on admission showed sinus rhythm (heart rate=76 beats per minute) without any significant ST-T changes.
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An initial electrocardiogram (ECG) showed no significant ST-T changes (Fig. 1), the findings for troponin-T were negative (troponin-I level was 6.5 pg/mL), and transthoracic echocardiography showed no segmental asynergy at rest.
Coronary angiography and the acetylcholine provocation test. (a) The left cranial view of the left coronary artery. (b) The right caudal view of the left coronary artery. There was no organic stenosis, including in-stent restenosis. (c) The left cranial view of the left coronary artery after the administration of acetylcholine chloride. (d) The right caudal view of the left coronary artery after the administration of acetylcholine chloride. Excessive coronary spasm was induced only by 20 microg administration of acetylcholine chloride. The drug-eluting stent previously implanted in the left circumflex artery is indicated by arrows.
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Despite the continuous administration of an oral calcium channel blocker during the test, the administration of only 20 mug of acetylcholine chloride into the left coronary artery induced excessive spasm (Fig. 2) and total occlusion of the left anterior descending artery, with ST segment elevation in leads I, aVL, and V2-6 accompanied by reciprocal changes in leads II, III, and aVF (Fig. 3).