Methylergometrine-induced coronary artery spasm causing total occlusion of all three coronary arteries.

In a 58-year-old man with rheumatic mitral valve disease and nocturnal chest pain of recent onset, intravenous injection of 0.4 mg methylergometrine during coronary angiography resulted in the total occlusion of all three angiographically normal coronary arteries, with electromechanical dissociation. Intravenous isosorbide dinitrate failed to relieve coronary spasm which had to be treated by intracoronary administration of nitrates and nifedipine.