This document discusses the evaluation and management of patients presenting with chest pain. It outlines the various potential causes of chest pain, both cardiac and non-cardiac. When evaluating patients, clinicians must choose the optimal diagnostic test based on factors like the patient's history, symptoms, and ability to exercise. Functional tests like exercise ECG, stress echocardiography, and nuclear imaging can detect ischemia but have limitations. Anatomic tests like coronary CT angiography provide high sensitivity but expose patients to radiation. The document provides guidance on selecting the most appropriate initial diagnostic evaluation based on individual patient characteristics and test attributes.