Chest pain is a common health problem and a leading reason for emergency room visits. The evaluation and treatment of cardiac causes of chest pain in women presents a unique challenge because they differ from men in the manner of symptoms, underlying causes, and risk factors. Women are often underdiagnosed and undertreated, resulting in poorer health. Women are more likely than men to have myocardial infarction without coronary artery occlusion, spontaneous coronary artery disease, and Takotsubo syndrome. Diseases of the heart valves have special characteristics in women. Other factors such as age, polycystic ovary syndrome, and pregnancy increase cardiovascular risk in women, but little evidence is available regarding optimal investigation and treatment in these special patient groups. When evaluating chest pain in women, it is important to understand the differences in the presentation of symptoms and the interpretation of diagnostic tests.