When patients present with chest pain, clinical examinations and histories are fundamental to determine the probable cause of pain and the selection of appropriate tests to confirm clinical suspicions. Cardiac ischemia due to coronary artery disease is frequently entertained as a diagnosis in these patients, as well as in certain patients presenting with new arrhythmias or congestive heart failure. Imaging evaluation of the coronary arteries is undertaken only after a full clinical evaluation with diagnostic testing (eg, electrocardiography, serum cardiac enzyme testing, and/or myocardial perfusion scanning) indicates that coronary artery disease is reasonably likely to account for a patients complaints.