So this time we're going to be looking at the HUGE topic of acute coronary syndrome (ACS)! ACS ranges from patients who appear well at the time of their presentation, to those that have arrhythmias, haemodynamic instability, to those that are in cardiac arrest! There are around three quarters of a million ED chest pain attendances per year for acute chest pain and it accounts for around 25% of ED medical admissions!! Some of the treatments we’ll discuss for patients with ACS can have a huge affect on morbidity and mortality and we can make a real difference to our patients. The ESC guidelines are a fantastic resource to take a look at and we've listen the papers that form the evidence we cover in the podcast. We worry about missing ACS and conversely, with so many ‘suspected ACS patients’, we also worry about overly suspecting it and the subsequent burden of admissions and investigations that it may mean. We’re going to cover the approach to ACS in this episode in our standard format, all the way from definition, patho-physiology, assessment, investigations and management and cover aspects that are both new information and a sound revision of the topic. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James