Recurrent Myocardial Infarction in a Patient With MINOCA and a Negative Ergometrine Provocation Test

This case highlights the diagnostic challenge associated with coronary vasospasm, especially when accompanied by no provoked spasms on the ergometrine test in the acute setting of myocardial infarction with nonobstructive coronary arteries. Inexplicable myocardial infarction with nonobstructive coronary arteries after extensive evaluation should alert the clinician to the possibility of coronary vasospasm and the necessity of acetylcholine provocative testing in spite of a negative ergometrine provocation test. (Level of Difficulty: Intermediate.)