Multifocal spasm with acetylcholine in Prinzmetal angina

A 60-year-old female patient with Prinzmetal angina and a single non-critical (<50%) focal obstruction in the right coronary artery was referred for percutaneous coronary intervention. Coronary angiography with provocative testing using incremental doses of acetylcholine demonstrated diffuse mild vasoconstriction and multifocal hyperreactive vasoconstriction in apparently normal coronary segments but not at the site of the nonsignificant obstruction. We refrained from intervention and advised avoidance of beta-blockade, and continuation of medical therapy with nitrates and calcium antagonists. (Neth Heart J 2008;16:134-6.).