In the developed world, coronary heart disease is still the leading cause of death. Age is the single most important risk factor for coronary artery disease and an independent predictor of poor outcomes after an acute coronary syndrome. ACS refers to a group of conditions that are associated with acute myocardial ischemia and/or infarction due to varying degrees of reduction in coronary blood flow caused by plaque rupture/erosion and thrombosis formation or supply and demand mismatch.  Methods:- The study was done in a retrospective and cross-sectional design where patient’s files fulfilling the inclusion criteria were reviewed. Data was collected and analyzed in a descriptive manner using SPSS version 23 and Microsoft excel and data was presented in the form of frequency charts and bar charts.  Results:- Data on 151 patients were gathered from the sudan heart center; the majority of them were men between the ages of 65 and 70, ( 71.6 )percent of them had no co-morbidities, whereas (28.4) percent did. Genetic factors , smoking, and diabetes are by far the most common risk factors in men, whereas hypertension was the most prevalent risk factor in women. Troponin seemed to to be the most elevated cardiac marker.  Conclusion:- Obesity, hypertension, and smoking appear to be risk factors for typical ACS symptoms in older or younger patients in this study. However, Men appeared to be more susceptible to having acute coronary syndrome in old age than women, the majority of them had symptoms of chest pain, and shortness of breath and diaphoresis, and were at risk due to hypertension, smoking.  Recommendations:- Several benefits and drawbacks were formulated throughout the conduction of this study. Chronic diseases, as well as age-related physiological and pathological features, can influence the presentation of ACS symptoms in the elderly. Understanding the factors associated with symptoms may aid in the early detection and better medical treatment of patients suffering from acute coronary syndrome. Obtaining an accurate history of the patient with cardiac complaints is one of the most important tasks of clinical treatment and care providers. Identifying the symptoms of ACS is critical for effective and immediate treatment. The findings imply that individuals suspected of having heart ischemia disorders at emergency rooms should have their histories thoroughly examined.