The accurate assessment and triage of patients with potential ACS is a complex decision-making process based on information that is not entirely reliable. The knowledgeable EP recognizes that assessment of patients with chest pain requires an understanding of the various clinical presentations of ACS and high-risk patient types, as well as careful use of the available modalities to diagnose these syndromes efficiently while incurring minimal risk to the patients safety. The busy EP is faced with sick patients with chest pain daily, so that it behoove anyone in emergency medicine to familiarize themselves with these diagnostic pitfalls.