Chest pain evaluation: a common clinical problem.

The clinical approach described here initially utilizing a careful focused history and physical examination, 12 lead ECG, as well as serum biomarkers, allows for an informed initial impression of the chest pain patient. Based upon the findings the practitioner can then initiate appropriate therapy or further testing based on this solid database. The therapy can vary from simple medical therapy involving aspirin and beta blockers to an invasive evaluation potentially involving percutaneous coronary interventions. If further non-invasive evaluation is chosen, then the choices for testing are as outlined here. The guidelines listed will help in selecting the appropriate test for the individual patient. We believe the approach used in this paper will help insure high quality cost-effective care of the chest pain patient.