Background and Objective Many women do not recognize their risk for coronary heart disease, or identify and respond to cardiac symptoms by seeking medical assistance when symptoms occur. These factors contribute to delays in presentation at hospital, which means that women then have fewer treatment options. This study aimed to describe women's symptom experiences and treatment-seeking responses to first-time acute coronary syndrome (ACS). Subjects and Methods Ten women who had experienced their first ACS event, and who had undergone a percutaneous coronary intervention within 24 hours of presentation, consented to participate in semistructured interviews that focused on their experiences. These women's narratives of their symptoms and treatment-seeking responses were thematically analyzed. Results and Conclusion Women described several issues that contributed to quite complex, multifaceted decision-making processes, from symptom onset to treatment-seeking response, which often contributed to delays. These issues included the occurrence of sometimes intermittent early-warning or prodromal symptoms, the diversity of their symptom experience, beliefs in low vulnerability to coronary heart disease by the women themselves, and health professionals' responses, which did not always match their needs. Lack of awareness may be particularly important in first-time ACS event. Effective strategies need to be developed to address these issues, including public-education campaigns, and specific education regarding women for health professionals.