The major purpose of this study was to describe gender-related cognitive representations of symptoms of acute coronary syndrome and coping responses to the symptoms as correlates to pre-hospital delay. Data were collected from 131 hospitalised Omani patients for acute coronary syndrome (81 men and 50 women) using a structured interview. Statistical analyses indicated that women perceived themselves as less susceptible to acute coronary syndrome than men. They reported the symptoms, shortness of breath and nausea/vomiting, more frequently than did men. Men who reported shorter pre-hospital delay were more likely to be free from diabetes, report neck pain, not experience left arm pain, attribute the symptoms to cardiac origin and not use the coping responses, ‘wait and see’ and ‘attempted to relax’. Whereas, women with shorter pre-hospital delay were more likely to experience sweating, perceive greater overall intensity of the symptoms and not report fear of diagnostic procedures as a barrier to seek healthcare early. The findings of this study suggest that, in women, the emotional aspect of the symptoms dominates the cognitive appraisal process, whereas the pathological aspect of the symptoms dominates the appraisal process in men.