We describe the case of a 37-year-old man who presented with inferior wall myocardial infarction shortly after the concomitant use of cocaine and ethanol. The patient showed prompt ST resolution after thrombolytic therapy. Within two hours from his arrival at the hospital the patient had an episode of ventricular fibrillation, which was successfully treated with electrical cardioversion. Coronary angiography showed normal coronary arteries. The number of patients with acute myocardial infarction after the use of cocaine alone, or in combination with ethanol, is increasing in the USA and other countries; most are young adults. In Greece such cases are still rare, because of the lesser extent of cocaine abuse in the general population and the low sensitivity in recognising cocaine users who present with chest pain in the emergency department.