Clinical investigations from the RACP

Is this chest pain due to myocardial ischaemia?

Simon O’Connor



A careful history, ECG and appropriate investigations can help distinguish benign causes of chest pain from exertional angina and acute coronary syndrome.

Key Points

  • Careful history taking can help identify patients with angina and stratify their risk.
  • A resting ECG is essential for assessing risk and planning further investigations.
  • Typical angina symptoms and an abnormal ECG are an indication for early referral for coronary angiography.
  • Symptoms at rest and an abnormal ECG may be an indication to call an ambulance.
  • Other investigations that may be helpful include exercise stress ECGs, stress echocardiography and myocardial perfusion scanning, and CT coronary angiography.
  • A negative noninvasive test result does not exclude myocardial ischaemia, and continuing symptoms are an indication for referral.