Chest pain is among the most common causes of emergency room (ER) visits, making its diagnosis a challenging one. The causes of this symptom range from musculoskeletal causes to potentially life-threatening emergencies, such as coronary artery disease. The fact that its presentation is subjective makes it difficult for the clinician to assess it; wherefore, good clinical evaluation is mandatory. Most patients presenting with classical chest pain and accompanying symptoms are easily diagnostic-oriented; however, there are an important fraction of patients that will not present with typical symptomatology. This observation indicates that the diagnostic workup for chest pain needs to be a very thorough one and additionally a very time-effective one; that is why having specific guidelines for chest pain can be lifesaving. It is essential to accurately risk stratify these patients to improve ER efficiency and avoid unnecessary tests and admissions. For this, risk scores are very useful to give a more objective view and stratify our patient and guide the next steps to take. The use of imaging techniques as a first approach to chest pain has been something in constant evolution, but still in research, especially the use of the immediate exercise stress echocardiogram, which greatly reduces the time for diagnosis, compared to a full clinical workup. It is of remark that this is an introduction to chest pain and its most common causes; for the specific treatment for each suspected pathology, we refer to the next chapters in this book.
