Related Experiment Video
Updated: Jul 3, 2026

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
Atrioventricular Block Induced by Right Coronary Artery Spasm in Vasospastic Angina
Antonin Trimaille1, Loic Faucher2, Baudouin Koenig2
1Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; UR 3074 Translational CardioVascular Medicine CRBS, Strasbourg, France.
Background:
Vasospastic angina (VSA) is a reversible cause of myocardial ischemia due to transient coronary spasm and may rarely be associated with conduction disturbances.
Case Summary:
A 64-year-old man presented with nocturnal rest angina. The initial angiography results were normal. Holter monitoring during symptoms showed transient ST-segment elevation with Mobitz type I second-degree atrioventricular (AV) block progressing to 2:1 AV block, causing presyncope. He later experienced syncope. Repeat angiography revealed diffuse coronary vasospasm involving the right coronary artery, fully reversible with nitrates, confirming VSA. Verapamil therapy resulted in symptom resolution and no further conduction abnormalities during follow-up.
Discussion:
Right coronary artery spasm may induce transient AV block due to ischemia of the AV node.
Take-Home Messages:
VSA should be considered in unexplained AV block or syncope with ischemic electrocardiographic changes. Calcium-channel blockers are effective even in ischemia-induced conduction disorders.
Related Concept Videos
Angina I: Introduction
Dysrhythmias IV: Characteristics of Bradyarrhythmias
Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
Angina II: Classification
Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
Acute Coronary Syndrome I: Introduction

