The diagnosis and management of acute coronary syndromes have changed beyond recognition in the past 30 years. Prolonged bed rest, cocktails of questionable potions and the instilling of a lifelong fear of stressful situations have been replaced by standardised, proven therapies administered within a strict timeline, and an early return to full activities. Of all patients who have a myocardial infarction, 25-35% will die before they receive medical attention, usually because of ventricular fibrillation. Vigorous and effective primary cardiovascular prevention has reduced the incidence of myocardial infarction, and secondary prevention has reduced the incidence of further infarction, associated heart failure and other complications. general practitioners play a major role in diagnosing acute coronary syndromes, educating patients about 'danger signals' and managing the return to normal life after the event. Angioplasty for acute myocardial infarction is termed primary angioplasty. Larger myocardial infarctions tend to be associated with more complications, such as heart failure, pericarditis and arrhythmias.