Arrhythmogenic Isolated Right Coronary Vasospasm

Coronary vasomotion disorders, although prevalent among patients with ischemia, remain poorly understood given limited use of invasive functional testing.

Presented here is a case of isolated severe right-coronary-artery vasospasm with acetylcholine reactivity testing resulting in ventricular arrhythmias.

Determining the type of coronary vasomotion disorder is important for providing the appropriate treatment; therefore, performing invasive functional testing is critical. Although isolated right-coronary-artery vasospasm is rare, if vasospastic angina is of high suspicion, evaluating the right coronary artery is necessary.

Vasospastic angina can occur in any phase of coronary atherosclerotic disease and result in myocardial infarction or sudden cardiac death. Vasomotor disorders can involve variable regions and combinations of microvascular and epicardial coronary arteries. A comprehensive diagnosis of vasomotor disorders is only possible with reactivity testing, with isolation of both right and left coronary arteries when indicated.