The use of cocaine as a recreational drug is rapidly escalating in this country. Because of this, an increase in cocaine-related morbidity and mortality is occurring. Cocaine toxicity has been recognized for several years and was thought to be related to high doses or repeated use. Now several researchers have reported that even recreational use of cocaine may cause serious injury and even death by precipitating an acute myocardial infarction (MI). This paper explores the relationship between cocaine abuse and acute MI as well as the care of the patient with a cocaine-induced MI.