Acute Coronary Syndrome (ACS) has a significant global impact and accounts for almost half of all cardiovascular related deaths in the United States. Myocardial infarction (MI) related to atherosclerotic plaque dislodgment and coronary artery occlusion constitutes Type 1 MI, the focus of this chapter. Early recognition and management of ACS with the goal of early revascularization is key to improving patient outcomes. Clinical presentation and electrocardiogram evaluation are crucial in diagnosis. Both pharmacological and non-pharmacological treatments are utilized during the acute management of ACS. Pharmacological management generally encompasses early symptom management, anticoagulation, and platelet inhibition. Both acute and long-term consequences may be evident following an MI with varying severity. Long-term management can be initiated in the inpatient setting as tolerated. Timely recognition, treatment, and secondary prevention are fundamental to survival and cardiovascular related outcomes.