[Myocardial infarct following a negative maximal exercise test: apropos of a case]

A 63-year-old patient, with effort angina diagnosed 3 months previously, suffered a myocardial infarction 6 minutes after a maximal exercise stress test which had given a normal result. Intravenous streptokinase, nitrates and calcium-antagonist treatment were performed immediately, but they failed to achieve myocardial re-perfusion. The patient refused coronary arteriography, but one year later underwent a further maximal exercise test, which gave a completely negative result. Here, we discuss hemodynamic mechanism likely to be involved in this rare event, and suggest that coronary arterial spasm might play an important role in inducing delayed myocardial ischemia.