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Updated: Aug 9, 2025

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
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Repetitive catamenial myocardial infarction due to coronary artery spasm: a case report

Nina Talmor1, Michael Gurin1, Nathaniel Smilowitz1

  • 1Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine 530 First Avenue New York, NY 10016, USA.

European Heart Journal. Case Reports
|February 16, 2023
PubMed

Insights

Catamenial coronary artery spasm, linked to menstrual cycles, can cause myocardial infarction with non-obstructive coronary arteries (MINOCA). Treatment involves calcium channel blockers and hormone suppression for symptom relief.

Area of Science:

  • Cardiology
  • Reproductive Endocrinology

Background:

  • Coronary artery spasm is a known cause of myocardial infarction with non-obstructive coronary arteries (MINOCA).
  • Potential mechanisms include smooth muscle hyperreactivity, endothelial dysfunction, and autonomic dysregulation.

Observation:

  • A 37-year-old woman experienced recurrent non-ST elevation myocardial infarction (NSTEMI) synchronized with her menstrual cycles.
  • Acetylcholine provocation confirmed coronary artery spasm in the left anterior descending artery, responsive to nitroglycerin.

Findings:

  • Treatment with calcium channel blockade and hormonal suppression effectively managed symptoms.
  • This led to the cessation of monthly NSTEMI events attributed to coronary spasm.

Implications:

  • Catamenial coronary artery spasm is a rare but significant cause of MINOCA.
  • This case highlights the importance of considering hormonal influences in MINOCA diagnosis and management.
Abstract

Keywords:
Acetylcholine provocation testingCase reportCatamenial vasospasmMenstruationNSTEMIVasospasmWomen’s Health

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