End-of-life care and cardiovascular disease are concepts that do not have the same synergy as end-of-life care and cancer. Cardiovascular care is predominantly perceived by patients and practitioners as a curative discipline. However, with the aging of the population and the prevalence of cardiovascular heart disease, it will continue to be the leading cause of death for adults in the United States. Clinical treatment options and issues surrounding end-of-life care need to be addressed with elderly patients and their families. The purpose of this article is to discuss the role of the cardiovascular nurse in the care of the elderly patient with acute coronary syndrome.