Background: Hyponatremia, characterized by low serum sodium levels, has been identified as a potential prognostic marker in acute coronary syndrome (ACS). However, its precise relationship with ACS prognosis remains unclear, necessitating further investigation. Aim: This study aims to determine the incidence of hyponatremia in ACS patients and assess its role as a prognostic indicator. Additionally, the correlation between hyponatremia levels and left ventricular dysfunction (LVD) on 2D echocardiography will be evaluated. Results: The study included 40 ACS patients, predominantly middle-aged males with evidence of cardiac muscle damage and moderate LVD. The prevalence of hyponatremia varied among different ACS types, with higher rates observed in ST-elevation myocardial infarction (STEMI) subtypes. Significant associations were found between LVD and the presence of hyponatremia, as well as between hyponatremia and mortality in ACS patients. Conclusion: Hyponatremia appears to be prevalent in ACS patients and may serve as a poor prognostic indicator. Its association with LVD and increased mortality highlights the importance of monitoring and managing sodium levels in ACS patients. Further research is needed to explore potential interventions and strategies for improving outcomes in ACS patients with hyponatremia.