Chest pain is a confronting symptom for patients and clinicians alike. Some patients presenting with chest pain will have serious acute illness with a high short-term risk of mortality, but this will be excluded in most patients. Chest pain is one of the most common causes of attendance at hospital emergency departments (EDs) and a frequent cause of presentations to general practice.1 Missed diagnosis, with associated adverse outcomes, can occur when chest pain assessment is based on clinical features alone.2