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Related Experiment Video

Updated: Jun 3, 2026

Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm

Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm

Published on: September 17, 2021

Coronary vasospasm: is it a myth?

Udo Sechtem¹, Peter Ong, Anastasios Athanasiadis

¹Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany. udo.sechtem@rbk.de

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions

|March 12, 2011

Summary

Coronary vasospasm causes angina pectoris, often mistaken for lesions. Intracoronary acetylcholine testing during catheterization accurately diagnoses vasospastic angina, enabling effective treatment with calcium antagonists and nitrates.

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Area of Science:

Cardiology
Vascular Medicine

Background:

Coronary vasospasm is a frequent cause of angina pectoris, affecting patients both with and without significant coronary artery disease.
Clinical suspicion of vasospasm is common, but non-invasive diagnostic methods are limited.

Observation:

Patients with vasospastic angina often undergo repeated invasive procedures due to misdiagnosis of coronary lesions.
Intracoronary acetylcholine testing during cardiac catheterization can confirm vasospasm.

Findings:

Epicardial vasospasm is identified in some patients, while others show microvascular spasm indicated by symptom reproduction and ischemic electrocardiogram changes.
Approximately 50% of positive tests reveal microvascular spasm rather than epicardial spasm.

Implications:

Accurate diagnosis of coronary vasospasm through acetylcholine testing facilitates appropriate treatment with calcium antagonists and nitrates.
Distinguishing between epicardial and microvascular spasm is crucial for effective management of vasospastic angina.