Evaluation in the emergency department of the patient with chest pain remains a common problem. Large numbers of patients are admitted to the hospital because of diagnostic uncertainty. Strategies dealing with this population include risk stratification by clinical presentation, serial cardiac enzyme assays to exclude myocardial infarction, and detection of myocardial ischemia with nuclear scintigraphy or echocardiography. Each of these strategies is rational with specific benefits and weaknesses. Bypassing these steps and performing immediate exercise testing is the newest approach that appears to be safe, timely, and cost-effective.
(Arch Intern Med. 1996;156:41-45)