Evidence has begun to accumulate that suggests there may be gender differences in the presenting symptoms of acute coronary syndromes (ACS). Identification of gender differences has implications for both health care providers and the general public. Women should be instructed as to the symptoms expected with ACS on the basis of evidence obtained from studies that include both sexes. Twelve studies that identified symptoms of ACS for both women and men were identified through a review of the literature. In several of the studies, which included all types of ACS, women had significantly more back and jaw pain, nausea and/or vomiting, dyspnea, indigestion, and palpitations. In a number of the studies, which solely sampled patients with acute myocardial infarction, women demonstrated more back, jaw, and neck pain; nausea and/or vomiting; dyspnea; palpitations; indigestion; dizziness; fatigue; loss of appetite; and syncope. Men reported more chest pain and diaphoresis in the myocardial infarction sample. Results of these studies showed that women and men experienced the same symptoms with ACS. However, in some studies there were gender differences in the proportion of symptoms. Given the current state of the science, definitive conclusions regarding gender differences in the symptoms of ACS cannot be drawn. Further study is urgently needed to clarify and expand on these findings.