Importance of a second spasm provocation test: Four cases with an initial negative spasm provocation test

Figure 2 Coronary angiograms during the first and second spasm provocation test in case 2. A: The first spasm provocation test (SPT) showed moderate vasoconstriction of the right coronary artery (RCA) after infusions of 50 μg acetylcholine (ACh) and moderate left coronary artery (LCA) vasoconstriction after infusions of 100 μg ACh. However, neither chest symptoms nor ST deviation of the electrocardiogram occurred during the SPT; B: The second SPT showed positive results with both the RCA after intracoronary infusions of 50 μg ACh and the LCA after infusions of 100 μg ACh, accompanied by the usual chest symptoms. Arrows indicate coronary spasms.