Key Points

Treatment

Design and created by Guideline Central in participation with the American College of Cardiology, American College of Chest Physicians, American Heart Association, American Society of Echocardiography, and Society of Cardiovascular Computed Tomography.

Evaluation and Diagnosis of Chest Pain

American College of Cardiology

American College of Chest Physicians

American Heart Association

American Society of Echocardiography

Society of Cardiovascular Computed Tomography

Publication Date: October 28, 2021

Top 10 Take-Home Messages:*

Chest Pain Means More Than Pain in the Chest. Pain, pressure, tightness, or discomfort in the chest, shoulders, arms, neck, back, upper abdomen, or jaw, as well as shortness of breath and fatigue should all be considered anginal equivalents.
High-Sensitivity Troponins Preferred. High-sensitivity cardiac troponins are the preferred standard for establishing a biomarker diagnosis of acute myocardial infarction, allowing for more accurate detection and exclusion of myocardial injury.
Early Care for Acute Symptoms. Patients with acute chest pain or chest pain equivalent symptoms should seek medical care immediately by calling 9-1-1. Although most patients will not have a cardiac cause, the evaluation of all patients should focus on the early identification or exclusion of life-threatening causes.
Share the Decision-Making. Clinically stable patients presenting with chest pain should be included in decision-making; information about risk of adverse events, radiation exposure, costs, and alternative options should be provided to facilitate the discussion.
Testing Not Needed Routinely for Low-Risk Patients. For patients with acute or stable chest pain determined to be low risk, urgent diagnostic testing for suspected coronary artery disease is not needed.
Pathways. Clinical decision pathways for chest pain in the emergency department and outpatient settings should be used routinely.
Accompanying Symptoms. Chest pain is the dominant and most frequent symptom for both men and women ultimately diagnosed with Acute Coronary Syndrome. Women may be more likely to present with accompanying symptoms such as nausea and shortness of breath.
Identify Patients Most Likely to Benefit From Further Testing. Patients with acute or stable chest pain who are at intermediate risk or intermediate to high pre-test risk of obstructive coronary artery disease, respectively, will benefit the most from cardiac imaging and testing.
Noncardiac Is In. Atypical Is Out. “Noncardiac” should be used if heart disease is not suspected. “Atypical” is a misleading descriptor of chest pain, and its use is discouraged.
Structured Risk Assessment Should Be Used. For patients presenting with acute or stable chest pain, risk for coronary artery disease and adverse events should be estimated using evidence-based diagnostic protocols.

* Figure 1 illustrates the take-home messages.

Table 1. Chest Pain Characteristics and Corresponding Causes

Nature

Anginal symptoms are perceived as retrosternal chest discomfort (e.g., pain, discomfort, heaviness, tightness, pressure, constriction, squeezing) (Section 1.4.2, Defining Chest Pain).
Sharp chest pain that increases with inspiration and lying supine is unlikely related to ischemic heart disease (e.g., these symptoms usually occur with acute pericarditis).

Onset and duration

Anginal symptoms gradually build in intensity over a few minutes.
Sudden onset of ripping chest pain (with radiation to the upper or lower back) is unlikely to be anginal and is suspicious of an acute aortic syndrome.
Fleeting chest pain—of few seconds’ duration—is unlikely to be related to ischemic heart disease.

Location and radiation

Pain that can be localized to a very limited area and pain radiating to below the umbilicus or hip are unlikely related to myocardial ischemia.

Severity

Ripping chest pain (“worse chest pain of my life”), especially when sudden in onset and occurring in a hypertensive patient, or with a known bicuspid aortic valve or aortic dilation, is suspicious of an acute aortic syndrome (e.g., aortic dissection).

Precipitating factors

Physical exercise or emotional stress are common triggers of anginal symptoms.
Occurrence at rest or with minimal exertion associated with anginal symptoms usually indicates ACS.
Positional chest pain is usually nonischemic (e.g., musculoskeletal).

Relieving factors

Relief with nitroglycerin is not necessarily diagnostic of myocardial ischemia and should not be used as a diagnostic criterion.

Associated symptoms

Common symptoms associated with myocardial ischemia include, but are not limited to, dyspnea, palpitations, diaphoresis, lightheadedness, presyncope or syncope, upper abdominal pain, or heartburn unrelated to meals and nausea or vomiting.
Symptoms on the left or right side of the chest, stabbing, sharp pain, or discomfort in the throat or abdomen may occur in patients with diabetes, women, and elderly patients.

Table 2. Physical Examination in Patients With Chest Pain

Clinical Syndrome	Findings
Emergency
ACS	Diaphoresis, tachypnea, tachycardia, hypotension, crackles, S3, MR murmur; examination may be normal in uncomplicated cases
PE	Tachycardia + dyspnea—>90% of patients; pain with inspiration
Aortic dissection	Connective tissue disorders (e.g., Marfan syndrome), extremity pulse differential (30% of patients, type A>B) Severe pain, abrupt onset + pulse differential + widened mediastinum on CXR >80% probability of dissection Frequency of syncope >10%, AR 40%–75% (type A)
Esophageal rupture	Emesis, subcutaneous emphysema, pneumothorax (20% patients), unilateral decreased or absent breath sounds
Other
Noncoronary cardiac: AS, AR, HCM	AS: Characteristic systolic murmur, tardus or parvus carotid pulse AR: Diastolic murmur at right of sternum, rapid carotid upstroke HCM: Increased or displaced left ventricular impulse, prominent a wave in jugular venous pressure, systolic murmur
Pericarditis Myocarditis	Fever, pleuritic chest pain, increased in supine position, friction rub Fever, chest pain, heart failure, S3
Esophagitis, peptic ulcer disease, gall bladder disease	Epigastric tenderness Right upper quadrant tenderness, Murphy sign
Pneumonia	Fever, localized chest pain, may be pleuritic, friction rub may be present, regional dullness to percussion, egophony
Pneumothorax	Dyspnea and pain on inspiration, unilateral absence of breath sounds
Costochondritis, Tietze syndrome	Tenderness of costochondral joints
Herpes zoster	Pain in dermatomal distribution, triggered by touch; characteristic rash (unilateral and dermatomal distribution)

Table 3. Contraindication by Type of Imaging Modality and Stress Protocol

aExercise ECG	Stress Nuclear^a
Abnormal ST changes on resting ECG, digoxin, left bundle branch block, Wolff-Parkinson-White pattern, ventricular paced rhythm (unless test is performed to establish exercise capacity and not for diagnosis of ischemia) Unable to achieve ≥5 METs or unsafe to exercise High-risk unstable angina or AMI (<2 d) i.e., active ACS Uncontrolled heart failure Significant cardiac arrhythmias (e.g., VT, complete atrioventricular block) or high risk for arrhythmias caused by QT prolongation Severe symptomatic aortic stenosis Severe systemic arterial hypertension (e.g., ≥200/110 mm Hg) Acute illness (e.g., acute PE, acute myocarditis/pericarditis, acute aortic dissection)	High-risk unstable angina, complicated ACS or AMI (<2 d) Contraindications to vasodilator administration Significant arrhythmias (e.g., VT, second- or third-degree atrioventricular block) or sinus bradycardia <45 bpm Significant hypotension (SBP <90 mm Hg) Known or suspected bronchoconstrictive or bronchospastic disease Recent use of dipyridamole or dipyridamole-containing medications Use of methylxanthines (e.g., aminophylline, caffeine) within 12 hours Known hypersensitivity to adenosine, regadenoson Severe systemic arterial hypertension (e.g., ≥200/110 mm Hg)
Stress Echocardiography	Stress CMR	CCTA
Limited acoustic windows (e.g., in COPD patients) Inability to reach target heart rate Uncontrolled heart failure High-risk unstable angina, active ACS or AMI (<2 d) Serious ventricular arrhythmia or high risk for arrhythmias attributable to QT prolongation Respiratory failure Severe COPD, acute pulmonary emboli, severe pulmonary hypertension Contraindications to dobutamine (if pharmacologic stress test needed) atrioventricular block, uncontrolled atrial fibrillation Critical aortic stenosis^b Acute illness (e.g., acute PE, acute myocarditis/pericarditis, acute aortic dissection) Hemodynamically significant LV outflow tract obstruction Contraindications to atropine use: Narrow-angle glaucoma Myasthenia gravis Obstructive uropathy Obstructive gastrointestinal disorders Severe systemic arterial hypertension (e.g., ≥200/110 mm Hg) Use of Contrast Contraindicated in: Hypersensitivity to perflutren Hypersensitivity to blood, blood products, or albumin (for Optison only)	Reduced GFR (<30 mL/min/1.73 m²) Contraindications to vasodilator administration Implanted devices not safe for CMR or producing artifact limiting scan quality/interpretation Significant claustrophobia Caffeine use within last 12 h	Allergy to iodinated contrast Inability to cooperate with scan acquisition and/or breath-hold instructions; Clinical instability (e.g. acute respiratory distress, severe hypotension, unstable arrhythmia); Renal impairment as defined by local protocols Contraindication to beta blockade in the presence of an elevated heart rate and no alternative medications available for achieving target heart rate; Heart rate variability and arrhythmia; Contraindication to nitroglycerin (if indicated)

aExercise ECG

Stress Nuclear^a

Abnormal ST changes on resting ECG, digoxin, left bundle branch block, Wolff-Parkinson-White pattern, ventricular paced rhythm (unless test is performed to establish exercise capacity and not for diagnosis of ischemia)
Unable to achieve ≥5 METs or unsafe to exercise
High-risk unstable angina or AMI (<2 d) i.e., active ACS
Uncontrolled heart failure
Significant cardiac arrhythmias (e.g., VT, complete atrioventricular block) or high risk for arrhythmias caused by QT prolongation
Severe symptomatic aortic stenosis
Severe systemic arterial hypertension (e.g., ≥200/110 mm Hg)
Acute illness (e.g., acute PE, acute myocarditis/pericarditis, acute aortic dissection)

High-risk unstable angina, complicated ACS or AMI (<2 d)
Contraindications to vasodilator administration
- Significant arrhythmias (e.g., VT, second- or third-degree atrioventricular block) or sinus bradycardia <45 bpm
- Significant hypotension (SBP <90 mm Hg)
- Known or suspected bronchoconstrictive or bronchospastic disease
- Recent use of dipyridamole or dipyridamole-containing medications
- Use of methylxanthines (e.g., aminophylline, caffeine) within 12 hours
- Known hypersensitivity to adenosine, regadenoson
Severe systemic arterial hypertension (e.g., ≥200/110 mm Hg)

Stress Echocardiography

Stress CMR

CCTA

Limited acoustic windows (e.g., in COPD patients)
Inability to reach target heart rate
Uncontrolled heart failure
High-risk unstable angina, active ACS or AMI (<2 d)
Serious ventricular arrhythmia or high risk for arrhythmias attributable to QT prolongation
Respiratory failure
Severe COPD, acute pulmonary emboli, severe pulmonary hypertension
Contraindications to dobutamine (if pharmacologic stress test needed)
- atrioventricular block, uncontrolled atrial fibrillation
- Critical aortic stenosis^b
- Acute illness (e.g., acute PE, acute myocarditis/pericarditis, acute aortic dissection)
- Hemodynamically significant LV outflow tract obstruction
- Contraindications to atropine use:
  - Narrow-angle glaucoma
  - Myasthenia gravis
  - Obstructive uropathy
  - Obstructive gastrointestinal disorders
  - Severe systemic arterial hypertension (e.g., ≥200/110 mm Hg)

Use of Contrast Contraindicated in:

Hypersensitivity to perflutren
Hypersensitivity to blood, blood products, or albumin (for Optison only)

Reduced GFR (<30 mL/min/1.73 m²)
Contraindications to vasodilator administration
Implanted devices not safe for CMR or producing artifact limiting scan quality/interpretation
Significant claustrophobia
Caffeine use within last 12 h

Allergy to iodinated contrast
Inability to cooperate with scan acquisition and/or breath-hold instructions;
Clinical instability (e.g. acute respiratory distress, severe hypotension, unstable arrhythmia);
Renal impairment as defined by local protocols
Contraindication to beta blockade in the presence of an elevated heart rate and no alternative medications available for achieving target heart rate;
Heart rate variability and arrhythmia;
Contraindication to nitroglycerin (if indicated)

For all the imaging modalities, inability to achieve high-quality images should be considered, in particular for obese patients.

^a Screening for potential pregnancy by history and/or pregnancy testing should be performed according to the local imaging facilities policies for undertaking radiological examinations that involve ionizing radiation in women of child-bearing age.

^bLow-dose dobutamine may be useful for assessing for low-gradient AS.

Table 4. Warranty Period for Prior Cardiac Testing

Test Modality	Result	Warranty Period
Anatomic	Normal coronary angiogram CCTA with no stenosis or plaque	2 y
Stress testing	Normal stress test (given adequate stress)	1 y

Table 5. Definition Used for Low-Risk Patients With Chest Pain

Low Risk (<1% 30-d Risk for Death or MACE)
hs-cTn Based
T-0	T-0 hs-cTn below the assay limit of detection or “very low” threshold if symptoms present for at least 3 h
T-0 and 1- or 2-h Delta	T-0 hs-cTn and 1- or 2-h delta are both below the assay “low” thresholds (>99% NPV for 30-d MACE)
Clinical Decision Pathway Based
HEART Pathway	HEART score <3, initial and serial cTn/hs-cTn < assay 99th percentile
EDACS	EDACS <16; initial and serial cTn/hs-cTn < assay 99th percentile
ADAPT	TIMI score 0, initial and serial cTn/hs-cTn < assay 99th percentile
mADAPT	TIMI score 0/1, initial and serial cTn/hs-cTn < assay 99th percentile
NOTR	0 factors

Class of Recommendations and Level of Evidence

Class (Strength) of Recommendation
CLASS I (STRONG)Benefit >>> Risk
Suggested phrases for writing recommendations: Is recommended Is indicated/useful/effective/beneficial Should be performed/administered/other Comparative-Effectiveness Phrases^†: Treatment/strategy A is recommended/indicated in preference to treatment B Treatment A should be chosen over treatment B
CLASS IIa (MODERATE) Benefit >> Risk
Suggested phrases for writing recommendations: Is reasonable Can be useful/effective/beneficial Comparative-Effectiveness Phrases^†: Treatment/strategy A is probably recommended/indicated in preference to treatment B It is reasonable to choose treatment A over treatment B
CLASS IIb (WEAK) Benefit ≥ Risk
Suggested phrases for writing recommendations: May/might be reasonable May/might be considered Usefulness/effectiveness is unknown/unclear/uncertain or not well established
CLASS III: No Benefit (MODERATE) (Generally, LOE A or B use only) Benefit = Risk
Suggested phrases for writing recommendations: Is not recommended Is not indicated/useful/effective/beneficial Should not be performed/administered/other
CLASS III: Harm (STRONG) Risk > Benefit
Suggested phrases for writing recommendations: Potentially harmful Causes harm Associated with excess morbidity/mortality Should not be performed/administered/other

Level (Quality) of Evidence^‡
LEVEL A
High-quality evidence^‡ from more than 1 RCT Meta-analyses of high-quality RCTs One or more RCTs corroborated by high-quality registry studies
LEVEL B-R (Randomized)
Moderate-quality evidence^‡ from 1 or more RCTs Meta-analyses of moderate-quality RCTs
LEVEL B-NR (Nonrandomized)
Moderate-quality evidence^‡ from 1 or more well-designed, well-executed nonrandomized studies, observational studies, or registry studies Meta-analyses of such studies
LEVEL C-LD (Limited Data)
Randomized or nonrandomized observational or registry studies with limitations of design or execution Meta-analyses of such studies Physiological or mechanistic studies in human subjects
LEVEL C-EO (Expert Opinion)
Consensus of expert opinion based on clinical experience

COR and LOE are determined independently (any COR may be paired with any LOE).

A recommendation with LOE C does not imply that the recommendation is weak. Many important clinical questions addressed in guidelines do not lend themselves to clinical trials. Although RCTs are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective.

* The outcome or result of the intervention should be specified (an improved clinical outcome or increased diagnostic accuracy or incremental prognostic information).
^† For comparative-effectiveness recommendations (COR I and IIa; LOE A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated.
^‡ The method of assessing quality is evolving, including the application of standardized, widely used, and preferably validated evidence grading tools; and for systematic reviews, the incorporation of an Evidence Review Committee.

COR indicates Class of Recommendation; EO, expert opinion; LD, limited data; LOE, Level of Evidence; NR, nonrandomized; R, randomized; RCT, randomized controlled trial.

Abbreviations

ACS: acute coronary syndrome

AMI: acute myocardial infarction

CABG: coronary artery bypass graft

CAC: coronary artery calcium

CAD: coronary artery disease

CCTA: cardiac computed tomography angiography

CDPs: clinical decision pathways

CMR: cardiac magnetic resonance

cTn: cardiac troponin

ECG: electrocardiogram

ED: emergency department

EMS: emergency medical services

FFR-CT: fractional flow reserve with CT

GDMT: guideline-directed medical therapy

hs-cTn: high-sensitivity cardiac troponin

ICA: invasive coronary angiography

INOCA: ischemia with nonobstructive coronary artery

MACE: major adverse cardiac event

MBFR: myocardial blood flow reserve

METs: metabolic equivalents

MINOCA: myocardial infarction and nonobstructive coronary arteries

MPI: myocardial perfusion imaging

NSTE-ACS: non-ST-elevation acute coronary syndrome

PCI: percutaneous coronary intervention

PE: pulmonary embolism

PET: positron emission tomography

SIHD: stable ischemic heart disease

SPECT: single-photon emission computerized tomography

STEMI: ST-elevation myocardial infarction

TEE: transesophageal echocardiography

TTE: Transthoracic echocardiography

VF: ventricular fibrillation

VHD: valvular heart disease

VT: ventricular tachycardia

Source Citation

Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Oct 28:CIR0000000000001029. doi: 10.1161/CIR.0000000000001029. Epub ahead of print. PMID: 34709879.

Disclaimer

This resource is for informational purposes only, intended as a quick-reference tool based on the cited source guideline(s), and should not be used as a substitute for the independent professional judgment of healthcare providers. Practice guidelines are unable to account for every individual variation among patients or take the place of clinician judgment, and the ultimate decision concerning the propriety of any course of conduct must be made by healthcare providers after consideration of each individual patient situation. Guideline Central does not endorse any specific guideline(s) or guideline recommendations and has not independently verified the accuracy hereof. Any use of this resource or any other Guideline Central resources is strictly voluntary.

Respiratory	Pulmonary embolism	Bronchitis
	Pneumothorax/hemothorax	Pleural irritation
	Pneumomediastinum	Malignancy
	Pneumonia
Gastrointestinal	Cholecystitis	Peptic ulcer disease
	Pancreatitis	Esophageal spasm
	Hiatal hernia	Dyspepsia
	Gastroesophageal reflux disease/gastritis/esophagitis
Chest wall	Costochondritis	Breast disease
	Chest wall trauma or inflammation	Rib fracture
	Herpes zoster (shingles)	Musculoskeletal injury/spasm
	Cervical radiculopathy
Psychological	Panic disorder	Somatization disorder
	Anxiety	Hypochondria
	Clinical depression
Other	Hyperventilation syndrome	Prolapsed intervertebral disc
	Carbon monoxide poisoning	Thoracic outlet syndrome
	Sarcoidosis	Adverse effect of certain medications (e.g., 5-fluorouracil)
	Lead poisoning	Sickle cell crisis

Evaluation and Diagnosis of Chest Pain

Key Points

Scope of the Problem

Synopsis

Top 10 Take-Home Messages:*

Figure 1. Take-Home Messages for the Evaluation and Diagnosis of Chest Pain

Figure 1. Take-Home Messages for the Evaluation and Diagnosis of Chest Pain Cont'd

Treatment

1.4.2. Defining Chest Pain

2. Initial Evaluation

2.1 Recommendation for History

Figure 2. Index of Suspicion That Chest “Pain” Is Ischemic in Origin on the Basis of Commonly Used Descriptors

Figure 3. Top 10 Causes of Chest Pain in the ED Based on Age (Weighted Percentage)

Table 1. Chest Pain Characteristics and Corresponding Causes

2.1.1. Focus on the Uniqueness of Chest Pain in Women

2.1.2. Considerations for Older Patients With Chest Pain

2.1.3. Considerations for Diverse Patient Populations With Chest Pain

2.1.4. Patient-Centric Considerations

2.2. Physical Examination

Table 2. Physical Examination in Patients With Chest Pain

2.3. Diagnostic Testing

2.3.1. Setting Considerations

2.3.2. Electrocardiogram (ECG)

Figure 4. Electrocardiographic-Directed Management of Chest Pain

2.3.3. Chest Radiography

2.3.4. Biomarkers

Figure 5. Chest Pain and Cardiac Testing Considerations

Figure 6. Choosing the Right Diagnostic Test

Table 3. Contraindication by Type of Imaging Modality and Stress Protocol

Figure 7. Patient-Centric Algorithms for Acute Chest Pain

4.1 Patients With Acute Chest Pain and Suspected ACS (Not Including STEMI)

Figure 8. General Approach to Risk Stratification of Patients With Suspected ACS

Table 4. Warranty Period for Prior Cardiac Testing

4.1.1. Low-Risk Patients With Acute Chest Pain

Table 5. Definition Used for Low-Risk Patients With Chest Pain

4.1.2. Intermediate-Risk Patients With Acute Chest Pain

4.1.2.1. Intermediate-Risk Patients With No Known (CAD)

Anatomic Testing

Stress Testing

Sequential or Add-on Diagnostic Testing

Figure 9. Evaluation Algorithm for Patients With Suspected ACS at Intermediate Risk With No Known CAD

4.1.2.2. Intermediate-Risk Patients With Acute Chest Pain and Known CAD

Figure 10. Evaluation Algorithm for Patients With Suspected ACS at Intermediate Risk With Known CAD

4.1.3. High-Risk Patients With Acute Chest Pain

4.1.4. Acute Chest Pain in Patients With Prior CABG Surgery

4.1.5. Evaluation of Patients With Acute Chest Pain Receiving Dialysis

4.1.6. Evaluation of Acute Chest Pain in Patients With Cocaine and Methamphetamine Use

4.1.7. Shared Decision-Making in Patients With Acute Chest Pain

4.2. Evaluation of Acute Chest Pain With Nonischemic Cardiac Pathologies

4.2.1. Acute Chest Pain With Suspected Acute Aortic Syndrome

4.2.2. Acute Chest Pain With Suspected PE

4.2.3. Acute Chest Pain With Suspected Myopericarditis

4.2.4. Acute Chest Pain With Valvular Heart Disease

4.3 Evaluation of Acute Chest Pain With Suspected Noncardiac Causes

Table 6. Differential Diagnosis of Noncardiac Chest Pain

4.3.1. Evaluation of Acute Chest Pain With Suspected Gastrointestinal Syndromes

4.3.2. Evaluation of Acute Chest Pain With Suspected Anxiety and Other Psychosomatic Considerations

4.3.3. Evaluation of Acute Chest Pain in Patients With Sickle Cell Disease

Figure 11. Pretest Probabilities of Obstructive CAD in Symptomatic Patients According to Age, Sex, and Symptoms

5.1.2. Low-Risk Patients With Stable Chest Pain and No Known CAD

5.1.3. Intermediate-High Risk Patients With Stable Chest Pain and No Known CAD

Anatomic Testing

Stress Testing

Assessment of Left Ventricular Function

Secondary Diagnostic Testing: What to Do If Index Test Results Are Positive or Inconclusive

Sequential or Add-on Diagnostic Testing

Figure 12. Clinical Decision Pathway for Patients With Stable Chest Pain and No Known CAD

5.2. Patients With Known CAD Presenting With Stable Chest Pain

5.2.1. Patients With Obstructive CAD Who Present With Stable Chest Pain

Index Diagnostic Testing

Anatomic Testing

Stress Testing

Figure 13. Clinical Decision Pathway for Patients With Stable Chest Pain (or Equivalent) Symptoms With Prior MI, Prior Revascularization, or Known CAD on Invasive Coronary Angiography or CCTA, Including Those With Nonobstructive CAD

5.2.1.1. Patients With Prior Coronary Artery Bypass Surgery With Stable Chest Pain

5.2.2. Patients With Known Nonobstructive CAD Presenting With Stable Chest Pain

Index Diagnostic Testing: Selecting the Appropriate Test

Anatomic Testing

Stress Testing

5.2.3. Patients With Ischemia and No Obstructive CAD (INOCA)

Figure 14. Clinical Decision Pathway for INOCA