Coronary Heart Disease (CHD) is one of the leading causes of death worldwide. In New Zealand CHD accounts for more than 15% of the annual mortality (Ministry of Health, 2018). Acute Coronary Syndrome (ACS) is an umbrella term used for Unstable Angina (UA), ST Elevation Myocardial Infarction (STEMI) and Non-ST Elevation Myocardial Infarction (NSTEMI). In this spectrum of disease, pre-hospital delay and decision making remains the main concern in accessing medical care in a timely manner to avoid negative outcomes in patients. This research identified a paucity of studies, especially qualitative studies in Aotearoa New Zealand to explore concerns related to this problem. Moreover, no studies expressly addressed pre-hospital decision delay and symptom experiences in residents of South Canterbury. This retrospective qualitative study aimed to explore the decision-making process for five participants from South Canterbury, when they experienced ACS. Semi-structured interviews were used to collect data from individual participants. The data was collected and recorded verbatim by the author and transcribed by a transcriber. Thematic analysis was used to analyse the transcribed data, which generated eight major and eleven subthemes. The study recognised various factors (personal, familial, cultural and educational) which led to the participants’ decision delay. The participants of this study experienced subtle and less intense symptoms which affected the interpretation of their symptoms as critical and thus delayed their calling for help. It is concluded from the findings of the study that pre-hospital delay and decision making remains as a major obstacle to seek immediate medical care. Thus, educating general public and high-risk patients and their family regarding possible typical and atypical symptoms of ACS could be helpful to assist in recognising when their symptoms are serious and when there is a need to call an ambulance immediately.