“…and coronary spasm. [15][16][17][18][19] Several lines of evidence point to underlying ischemia causing chest pain in MVP patients including electrocardiographic abnormalities, 1-5 arrhythmias '20-2:1 increased myocardial lactate production in MVP patients during ventricular pacing, 21 myocardial infarction 1;),2;) and sudden death. 26 Early speculation that coronary spasm caused chest pain in patients with MVP was based on circumstantial evidence such as documented myocardial infarction in a small number of patients with MVP and angiographically normal coronary arteries and occasional reports of ST segment elevation in MVP patients during pain.ls While several series showed angiographic evidence of coronary spasm in a few patients with MVP, 14,17,HJ the spasm often occurred around the catheter tip.17 Ergonovine testing in MVP patients with atypical chest pain has been largely unrewarding.…”