Cocaine abuse has been associated with various cardiovascular complications, including angina pectoris, myocardial infarction, and sudden cardiac death. The first report of myocardial infarction temporally related to the recreational use of cocaine appeared in 1982. This article discusses the possible pathological mechanisms underlying the pathogenesis of myocardial ischemia and infarction secondary to cocaine abuse, and current ideas on the management of cocaine-induced myocardial infarction. We report a case of acute myocardial ischemia in a young healthy male patient and his 5-year follow-up