Background: The clinical profile among patients with acute coronary syndromes (ACS) is not well studied in this western part of Nepal where Lumbini Medical College and Teaching Hospital (LMCTH) is situated. Cardiovascular disease is now the most common non communicable disease killing thousands of people worldwide. The trend of incidence is increasing in the developing countries including Nepal. Objective: To obtain the clinical profile of patient presenting with ACS in LMCTH. Material and Method: This is a prospective study carried out in LMCTH in the department of Internal Medicine April 14, 2013 to October 14, 2013. Patients were diagnosed to have ACS based on their clinical findings, Electrocardiogram (ECG) and Troponin test. Those with non-cardiac chest pain were excluded. A detail history and all the data pertaining to the patient were noted analyzed in a systematic way. Results: A total of 40 patients with ACS presented during the study period in LMCTH. The mean age of presentation was 67±18 years. Thirty out of those constitute male (75%). Six patients (15%) died during the study period. Seventeen (42.5%) presented with central chest pain, 13(32.5%) presented with left sided chest pain, 4(10%) presented with acute shortness of breath. Four (10%) patient presented in the state of cardiogenic shock and 2 (5%) presented with the Ventricular tachycardia (VT) as their complication. 6 (15%) had unstable angina (UA), 14 (35%) had Non ST elevation Myocardial Infarction (NSTEMI) and 20 (50%) had ST elevation Myocardial Infarction (STEMI). Of the total 20 (50%) patient who had STEMI, only four of them underwent thrombolysis. Anterior wall MI was the most common wall involved. Circadian variation study showed peak incidence of acute coronary syndrome during the early morning hours.  Mean duration of symptoms before presentation to the hospital facility was 4 days. Mean hospital stay was 5±2 days. Conclusion: Cardiovascular disease is common in this Western part of Nepal. STEMI was the commonest presentation and the incidence was more among the male and the elderly patients.