Electrical injury is uncommon, and cardiac involvement occurs in a minority of patients who are injured. Cardiovascular complications in the electrically injured patient, however, can be devastating. Because the presentation of electrical injury to the heart can be atypical in nature, delayed in onset, or obscured by other trauma, caution must be exercised in the interpretation of initial symptoms, ECGs, monitor strips, and cardiac enzymes. Whenever there is doubt concerning the presence of cardiovascular injury, the patient should be monitored. When cardiac complications are in evidence, expectant management is generally sufficient. When specific management of cardiac arrest, other dysrhythmias, myocardial necrosis, hypertension, or conduction abnormalities is required, standard therapeutic regimens are generally appropriate. In managing apparent acute myocardial infarction, however, the possibility that the injury is not of ischemic origin must be considered. Reperfusion techniques should be applied only when occlusive coronary thrombosis is strongly suspected or angiographically confirmed. The risk of developing chronic cardiac disease after electrical injury to the heart is unknown. Patients who sustain cardiovascular injuries should be followed for at least 12 months and avoid elective surgery for 6 months after the incident.