Cardiovascular diseases exert a huge burden on individuals and society, with coronary heart disease (CHD) the single most common cause of death in the United Kingdom and other developed countries (British Heart Foundation 2004). Improved clinical care has been responsible for around two fifths of the decline in mortality from CHD in England and Wales over the past decade (Unal et al 2004). This article describes how developments in cardiac care, most of which have closely engaged nurses, have contributed to improvements in care for patients with acute myocardial infarction and other acute coronary syndromes.