Cocaine use is escalating in the United States. Cocaine produces sympathomimetic effects and causes generalized vasocon-striction involving multiple organ systems. Its cardiovascular complications may be life-threatening and include myocardial infarction, myocarditis, cardiomyopathy, arrhythmias, and aortic dissection. Accurate diagnosis and prompt management can be life-saving. This review focuses on the current information available on the cardiovascular complications of cocaine and suggests guidelines regarding their management strategies.