Advances have occurred rapidly in how the patient who presents with acute ST elevation myocardial infarction is managed. Nevertheless, due to availability and effectiveness, medical therapy continues to be the mainstay of treatment. Several drugs are of proven efficacy in decreasing myocardial loss and mortality. Thrombolytics, antiplatelets, and anticoagulants combine to decrease the thrombus overlying the active plaque and thus increase blood flow to the infarcting myocardium. Beta blockers, nitrates, and angiotensin converting enzyme inhibitors diminish myocardial oxygen consumption and have been shown to decrease morbidity and mortality. Supportive therapies provide patient comfort and aid survival until definitive therapies are instituted. However, as advanced as treatments become, none are effective unless patients are educated to seek help quickly and emergency response systems are efficient. Health care providers must ensure patient education and prompt medical response in communities so that medical regimens can be as effective as possible.