Cardiovascular disease is the leading cause of death in women. Because of the protective effects of estrogens, ischemic heart disease occurs predominantly in the postmenopausal period and, therefore, much later than in men. The proportion of women with acute coronary syndromes who present with typical chest pain is the same as in men. Nevertheless, atypical chest pain, which is usually associated with a lower likelihood of significant coronary disease, occurs more frequently in women. It is within this context that the sensitivity and specificity of the non-invasive tests used for diagnosing ischemic heart disease are reviewed. In addition, the clinical characteristics, treatment and prognosis of acute coronary syndromes in women are described, while highlighting the contributions made by age and disease severity at presentation to the higher short-term mortality observed in female patients after acute myocardial infarction.