We examined factors associated with delay in seeking emergency medical attention for acute ischemic symptoms in a sample of predominantly African American women.Female patients who presented with symptoms of acute myocardial infarction (AMI) were interviewed. Qualitative and quantitative methods were used to examine barriers associated with delay.The mean hours of delay were 20.4 (median = 4.5 hours). Sixty-nine percent of the patients delayed 1 hour or more. These delays were associated with younger age, African American ethnicity, poorer self-rated health, and the belief that one could not personally ever have an AMI. In a multiple logistic regression model, the belief that one could not ever have an AMI significantly increased the odds of delay compared with other patient characteristics.The results indicate that efforts should be made to increase women’s awareness of personal risk for AMI and the need for development of cognitive representations of AMI.