Doing an ECG is of little use in predicting future heart problems for people who are examined because of chest pain.

Chest pain is the most common reason people seek medical attention for possible heart trouble, and an ECG is a common test for such people. ECG can be normal in the first six hours even in frank heart attacks. Missing the diagnosis of heart attack on ECG is the commonest mistake done in the emergency rooms.

The classical history and physical findings still remain the most important parameters.

• Chest pain, which can be pinpointed by a finger, is not a heart pain.
• Pain lasting less than 30 seconds is not a heart pain.
• Heart pain is diffuse pain in the center of the chest lasting more than minutes and manifesting as heaviness, burning, discomfort, heaviness or pain often precipitated by physical or mental exertion.

Do an exercise stress test when in doubt; if negative, these patients should be reassessed for risk factors.

If the patient is at high risk, then even with negative treadmill, he/she should undergo risk reduction management for prevention of future heart attacks.

High risk patients are smokers, those with presence of high blood pressure, obesity, high cholesterol and diabetes.