Investigating chest pain.

Chest pain is a common complaint that in many patients requires full investigation to exclude the possibility of heart disease. Simple tests such as ECG and chest X-ray are often unhelpful. The main investigation is an exercise test but interpretation of this is not simple and its usefulness is limited in middle-aged women. More sophisticated imaging such as thallium scanning and stress echocardiography are of limited additional benefit and have significant cost. Coronary angiography remains the gold standard for the assessment of coronary atherosclerosis.