Acute Coronary Syndrome Acute coronary syndrome (ACS) is a term that refers to the clinical symptoms of myocardial ischemia, unstable angina, and myocardial infarction (Overbaugh, 2009). It is one of the leading causes of death with more than 135,000 fatalities in Britain alone in the year 2000 (Jones, 2003). Chest pain (angina) remains the predominant symptom of ACS and can either be unstable or stable. In addition, ACS presents uncharacteristic symptoms such as indigestion, nausea, backache, and fatigue in women, which can slow down diagnosis and medication. Troponin T is the ideal and reliable cardiac biomarker in the diagnosis of ACS. Pathophysiology of Acute Coronary Syndrome The disruption of an arteriosclerotic plaque in the coronary artery fuels the accumulation of platelets and the establishment of a thrombus. These events initiate the beginning of ACS. Current statistics propose that the bursting of a volatile susceptible plaque alongside its related inflammatory alterations is largely accountable for the diminished blood flow, which consequently produces ischemia (Davies, 2000). Oxygen and energy (ATP) are essential for the continuation of contractility and electrical stability required in normal transmission (Overbaugh, 2009). When oxygen is unavailable glycogen is degraded anaerobically in the myocardial cells leading to the production of inadequate ATP. Consequently, the sodium-potassium and calcium pump malfunction. Hydrogen and lactate ions accumulate bringing about acidosis. Cell death or infarction then starts if interventions to reverse the situation are not initiated. Nursing and Medical Management of Acute Coronary Syndrome Effective management of ACS entails making the correct diagnosis and availing the required interventions in a timely manner (O’Connor et al., 2010). It is imperative that nurses grasp the idea of preload and afterload to comprehend the pharmacologic management of ACS. A rise in preload elevates strain on the heart and increases the risk of heart failure. Drugs such as morphine, nitroglycerin, and beta-blockers reduce preload, whereas inhibitors of angiotensin-converting enzyme (ACE) reduce afterload. ACS management is made easy by the creation of the mnemonic MONA (morphine sulphate, oxygen, nitroglycerin, and aspirin) to help nurses recall the required medication. Aspirin is administered immediately after the symptoms manifest since it prevents the constriction of blood vessels and the agglutination of platelets. Oxygen is the second regimen given “at 2 to 4 L/min by nasal cannula” (Overbaugh, 2009, p.48). Sufficient oxygen minimizes pain resulting from myocardial ischemia. 0.3 or 0.4 mg of nitroglycerin tablets given sublingually at intervals of five minutes trim down myocardial requirement for oxygen by reducing the preload and afterload. Nurses ought to monitor the drop in blood pressure and the intensity of pain. When all other attempts to manage pain fail, morphine sulphate is the ultimate choice and is administered intravenously at a dosage of 2 to 4 mg at intervals of 15 minutes. Reperfusion therapy (PCIs and fibrinolytic drug treatment) can be performed to reinstate blood flow to ischemic myocardial tissue thereby precluding additional hurdles, and i