I'm basically doctor house *swallows pills*. I have to type 50 words so here is some information about ACS! ACS is acute coronary syndrome and is a collection of signs and symptoms that indicate there is some sort of occlusion to the coronary vascular system possibly causing infarction or ischemia. when doing an EKG on someone with ACS if you have ST elevation in two CONTIGUOUS leads, it is indicative of myocardial infaction. ST segment depression however can mean ischemia, but if its depression in leads V1 and V2 then instead of being septal ischemia it could be a posterior myocardial infarction.