Cardiovascular problems are among the most frequently seen medical complaints related to cocaine use, with chest pain as the most commonly encountered cardiac emergency. Multiple studies and case reports have documented myocardial infarction in young, otherwise low-risk cocaine users. Treatment should be consistent with that of any patient with myocardial ischemia, with particular attention devoted to decreasing the sympathomimetic effects of the cocaine. A 24-hour observation period identifies close to 100% of patients sustaining an acute myocardial infarction after cocaine use.