The Acute Coronary Syndrome (ACS) is one of the most common and also life-threatening diseases. Elderly patients due to comorbidity and changes in anatomy and physiology of the body, present some differentiation in the clinical presentation of the disease and common symptoms. Aim: The purpose of this study was to review the literature about the specific characteristics that elderly people with ACS present. Method: A review of international and Greek bibliography of the last fifteen years was carried out for the collection of data, in the electronic repositories Pubmed and Sciencedirect, using the key-words: “acute coronary syndromes”, “elderly”, “diagnosis”, “treatment”, “thrombolysis”, “electrocardiogram” and also a combination of them. Results: The review of literature showed that elderly people with ACS present more atypical symptoms such as gastrointestinal and respiratory problems and less the typical chest pain. The diagnostic methods are the same for all ages, except that older patients often have changes on electrocardiogram that complicate the diagnosis and so they need more attention in management and a comparison with a previous recording, if available, is especially helpful. Regarding the therapy, greater caution is needed in elderly patients, because of comorbidities that often exist, while the process of drug metabolism by the body changes. Furthermore, elderly patients seem to particularly delay in seeking medical care and this can aggravate their condition. Conclusions: The symptoms of elderly people who suffer from ACS are to a great degree the same with those of younger patients. There are, however, many particular characteristics that health professionals have to take into account, mainly because of the comorbidities and changes in anatomy and physiology of elderly patients.