Determine the pretest probability of CHD based on the type of pain (angina, atypical angina, noncardiac chest pain) and the presence of cardiac risk factors.
Examine patients for signs of CHD and comorbid diseases that may precipitate angina (e.g., hypertrophic obstructive cardiomyopathy, aortic stenosis, anemia, hyperthyroidism, cocaine use).
Obtain a resting ECG in all patients without an obvious noncardiac cause of chest pain.
Obtain a chest X-ray in all patients with HF, valvular heart disease, pericardial disease, or aortic dissection or aneurysm.
Obtain echocardiography in patients with possible valvular disease or outflow obstruction, HF, or history of MI.
Perform an exercise treadmill test in patients who are able to exercise and do not have baseline abnormalities on their resting ECG.