Approximately 5 percent of all emergency department (ED) visits, or about 5 million visits a year, are for chest pain, yet accurate diagnosis remains a challenge. Owing to a complex interplay of anatomic, physiologic, and psychological factors, serious illness often mimics benign conditions. Symptoms are often intermittent, so the patient may appear well on evaluation. This chapter outlines an approach to patients presenting with chest pain and other symptoms of possible ischemia. Detailed discussion of patients with findings diagnostic of acute coronary syndromes (ACS) can be found in other chapters of this text.

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