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

Figure 4 Coronary angiograms during the first and second spasm provocation test in case 4. A: The first spasm provocation test (SPT) showed negative right coronary artery (RCA) results after an intracoronary infusion of 50 μg acetylcholine (ACh) and of the left coronary artery (LCA) after an intracoronary infusion of 100 μg Ach; B: The second SPT showed negative RCA results after an intracoronary infusion with 50 µg ACh, and severe vasoconstriction at the distal left anterior descending coronary artery, after an intracoronary infusion of 100 μg ACh. Arrows indicate coronary spasms.