Related Experiment Video
Updated: Sep 13, 2025

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
Recurrent Ventricular Fibrillation Due to Coronary Vasospasm Without Preceding ST-Segment Elevation or Chest Pain
Jeremy William1, Luigi Zanetti Ferreira2, Aleksandr Voskoboinik1
1The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.
Background:
Coronary vasospasm (CV) is a rare cause of malignant ventricular arrhythmia and cardiac arrest. It typically presents with chest pain and marked ST-segment elevation.
Case Summary:
We present the case of a 61-year-old man with recurrent malignant ventricular arrhythmia and implantable defibrillator shocks without preceding chest pain. The diagnosis of CV remained elusive for 3 months despite extensive investigation. Close inspection of telemetry revealed progressive ST-segment depression and T-wave inversion before arrest. Coronary angiography with low-dose acetylcholine testing revealed multivessel vasospasm. Vasodilator therapy was initiated with rapid elimination of ventricular arrhythmia.
Discussion:
This case highlights that cardiac arrest due to CV may present without the classical features of chest pain or ST-segment elevation, underscoring the value of provocation testing in unexplained arrhythmia.
Take-Home Messages:
CV may present without preceding angina or ST-segment elevation. Careful electrocardiogram review and early provocation testing can identify vasospasm and guide therapy.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
06:18Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm
Published on: September 17, 2021
Related Concept Videos
Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
Dysrhythmias II: Classification of Tachyarrhythmias
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
Dysrhythmias III: Characteristics of Dysrhythmias
ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
Acute Coronary Syndrome I: Introduction