A woman had diffuse vascular spasm related to cocaine use. She presented with evidence of an acute anterior myocardial infarction but had no rise in creatinine phosphokinase levels. Cardiac catheterization showed 90 percent proximal left main coronary artery narrowing. The catheterization was complicated by right femoral artery spasm. A repeat catheterization after treatment with nitroglycerin and diltiazem showed 30 percent proximal left main coronary artery narrowing. This catheterization was complicated by left femoral artery spasm. An exercise treadmill test was negative for ischemia.