White Clot Formation at Acetylcholine Testing

Abstract

Coronary intraluminal white clot formation, apparently in response to acetylcholine testing, may explain a woman’s long-term history of daily chest pain and multiple myocardial infarctions. Acetylcholine testing reproduced chest pain and revealed luminal filling defects in multiple vessels; imaging showed fresh white platelet clots. Antiplatelet prasugrel has substantially suppressed her symptoms. (Level of Difficulty: Advanced.)

Keywords

• angina pectoris
• coronary artery disease
• coronary vasospasm
• myocardial infarction
• platelet aggregation
• platelet aggregation inhibitors