Structural or functional coronary artery disease? Acetylcholine testing reveals epicardial spasm after multiple myocardial revascularizations

Brief Summary Determining the cause of angina remains challenging, because structural and functional abnormalities may be involved. We report the case of a 77-year-old male with recurrent chest pain at rest. The symptoms persisted despite surgical revascularization and percutaneous coronary interventions. Acetylcholine testing revealed epicardial coronary spasm as the cause for the patient's symptoms. Dual calcium channel blockade led to marked improvement.