P hysicians involved in acute medical take or emergency department work will be well aware of the various acute presentations associated with cocaine and amphetamine use. As the population ages and the heavy users from previous decades accumulate 'crack years', the longer term consequences of these drugs on the cardiovascular system are becoming more evident. This article will review the pharmacology of stimulant drugs and discuss acute and chronic problems associated with their use. Management strategies of acute presentations, including the role of vasodilators in cocaineinduced myocardial infarction, the avoidance of beta-blockers in acute toxicity and the potential role of alpha-2 agonists are discussed. The management of chronic cardiac damage associated with cocaine or amphetamine abuse has an insufficient evidence base to suggest anything other than complete abstinence in combination with well established therapies.

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