By Dr. R Ramaesh, Prof. D E Newby and Dr. M C Williams
Coronary heart disease (CHD) is a leading cause of mortality and morbidity, and a frequent cause of primary and secondary care attendance with chest pain. It is therefore paramount that patients who are at high risk are identified early, and appropriate treatment organised. However, clinical assessment alone can be challenging, as patients often present with atypical symptoms and pre-test probability scoring systems both under- and over-estimate risk.