Patients presenting to the Emergency Department with chest pain are common and often present diagnostic difficulties. Because of the limitations of the initial evaluation, the majority of patients are admitted, although many are later found to have noncardiac causes for their symptoms. Recognition of these limitations has driven the investigation of newer evaluation techniques and protocols in an attempt to improve diagnostic sensitivity without increasing overall costs. These have included modifications of the standard ECG, and use of newer myocardial markers such as mass assays for CK-MB and troponin T and I. Use of acute rest myocardial perfusion imaging has also been shown to be a highly valuable technique for risk stratification of the intermediate- to low-risk chest pain patient.