Evaluation of Chest Pain in the Emergency Department

l^hest pain is one of the most frequent symptoms for which patients are evaluated in an emergency department. Unless the cause of chest discomfort is clearly noncardiac, an evaluation to rule out acute myocardial infarction is usually initiated. Although the quality of chest pain can sometimes be helpful in decision making, it is clear that atypical chest pain does not exclude myocardial infarction (1-4). Assessment of risk factors for coronary artery dis-ease is also often unhelpful. Except for an occasional young patient with no risk factors in whom the probability of acute myocardial infarction is low, most patients with myocardial infarction who present with chest pain are middle-aged or elderly and have one or more risk factors (3, 4). Decision making often relies on electrocardiographi