Cocaine use in North America has reached epidemic proportions becoming one of the top causes of drug-related visits to US emergency rooms. The number of users has increased due to the popularity and accessibility of crack cocaine. The pharmacokinetic properties and effects of cocaine on the cardiovascular system can lead to serious complications. Cocaine is known to induce angina and precipitate myocardial infarction. Cocaine use has been associated with the development of dilated cardiomyopathy, left ventricular dysfunction, and can also predispose a patient to a variety of cardiac arrhythmias including sudden cardiac death. Additionally, cocaine use has been associated with spontaneous aortic and coronary dissection, mesenteric ischemia, stroke, venous thrombosis, and a variety of pulmonary complications. This review article focuses on the effects and complications of cocaine upon the cardiovascular system.