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Related Experiment Video

Updated: Jul 17, 2026

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders

Published on: August 18, 2016

[Shock during spasm provocation tests with acetylcholine: four case reports].

Akira Oshita¹, Yousuke Izoe, Hiroaki Kohno

¹Department of Cardiology, Saiseikai Saijo Hospital, Ehime. aoshita@saiseikaisaijo.jp

Journal of Cardiology

|February 3, 2007

Summary

The acetylcholine spasm provocation test can induce shock in patients with coronary vasospasm. Prompt treatment with intraarterial norepinephrine and isosorbide dinitrate can effectively manage this rare complication.

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Area of Science:

Cardiology
Diagnostic Procedures

Background:

The acetylcholine spasm provocation test is a valuable tool for diagnosing coronary artery vasospasm.
Coronary artery vasospasm can cause acute coronary syndromes, even without significant stenosis.

Observation:

Four patients experienced shock during acetylcholine spasm provocation tests.
This occurred in 0.36% of 1110 consecutive tests.
Shock was associated with diffuse severe coronary vasospasm in the left anterior descending and left circumflex arteries.

Findings:

Intracoronary acetylcholine injection can precipitate severe coronary vasospasm and shock.
The condition was successfully treated with intraarterial norepinephrine and isosorbide dinitrate.
Patients recovered from shock with prompt medical intervention.

Implications:

While the acetylcholine test is generally safe and reliable, clinicians must be vigilant for potential complications.
Careful monitoring and preparedness for managing vasospasm-induced shock are essential.
This highlights the importance of understanding and managing severe coronary vasospasm during diagnostic procedures.