Science and Education Publishing American Journal of Medical Case Reports 2374-216X 5 2 2017 2 23 Acute Cocaine Myocarditis: A Mimic of ST Elevation Myocardial Infarction 32 34 EN Abid Shah Department of Cardiology, Bridgeport Hospital Yale New Haven Health System, Bridgeport, CT, USA Maihemuti Axiyan Erol Nargileci Adam Schussheim Robert Fishman Greg Marrinan AJMCR2017522 10.12691/ajmcr-5-2-2 2016 9 17 2017 1 9 2017 2 21 Cocaine remains one of the most commonly abused drugs in the United States and ingestion often presents with chest pain. The American Heart Association (AHA) published guidelines in 2008 on cocaine associated myocardial infarction (MI) to help assess and manage patients with obstructive coronary artery disease (CAD) in a timely manner. Cocaine may cause MI through increased platelet activation or through coronary vasoconstriction and spasm. However, cocaine induced myocarditis presenting as ST elevation myocardial infarction (STEMI) is uncommon. We report a case of a 35-year-old male with no significant medical history who presented with an 8-hour history of central chest pain. The patient admitted to ingesting cocaine within the last 8 hours and urine toxicology was positive for cocaine metabolites. EKG showed ST segment elevations in leads I and aVL and the patient was taken urgently for coronary angiography. Coronary angiography revealed no significant obstructive CAD. Transthoracic echocardiogram showed mildly reduced left ventricular ejection fraction (LVEF) and Cardiac MRI showed late gadolinium enhancement of the inferior and septal segments consistent with myocarditis. Cardiac MRI with contrast is a useful modality in differentiating ischemic from non- ischemic causes of STEMI after cardiac catheterization.