Acute myocardial infarction provoked by a cold pressor test

Coronary artery spasm is a well documented cause of variant angina pectoris. It has also been postulated to cause acute myocardial infarction. The diagnosis of coronary artery spasm is frequently made by means of ergonovine provocation during cardiac catheterization. Spasm of the coronary arteries may also be provoked by the cold pressor test. We describe a patient in whom an acute myocardial infarction evolved after his chest pain was reproduced with a cold pressor test. We suggest that the cold pressor test should be performed with caution, and perhaps should be limited to the cardiac catheterization laboratory.