Chest pain is a typical feature of obstructive coronary disease, but unless carefully evaluated, may not be a reliable predictor in women. The use of standardized questionnaires and evaluation tools has been developed and validated in men, but only partially in women. If women over the age of 65 are evaluated, typical features of angina are much more reliable in representing coronary disease than in younger women, who may have risk factors, but are less likely to have significant coronary disease. Many studies have shown that chest pain is the most common presenting symptom for both men and women with unstable coronary syndromes or myocardial infarction. Other associated features, such as nausea, shortness of breath, and back pain, may be more common in women, while diaphoresis is more common in men. Since men and women at risk for coronary disease should be evaluated when any potential symptoms emerge, it is useful to employ a standardized assessment of the characteristics of the symptoms as well as a uniform approach to further evaluation.