Spontaneous multivessel coronary vasospasm leading to cardiogenic shock.

We report a case of spontaneous multivessel coronary vasospasm leading to anterior myocardial infarction and cardiogenic shock in the setting of treatment with methylphenidate and withdrawal from beta-blockers and calcium channel-antagonists. The patient was stabilized with an intra-aortic balloon pump and treated with coronary stenting and vasodilators and ultimately had an uneventful recovery. We review the diagnosis and treatment of coronary vasospasm and the implications of coronary vasoreactivity in the pathophysiology of myocardial infarction.