Effort-related pain and two or more episodes of pain in 24 hours are associated with poor outcomes in patients presenting with chest pain of uncertain origin, according to a study, from Spain, in the BMJ. Dr Peter Savill comments:'Patients presenting with chest pain can be a real challenge. Furthermore, an ECG is rarely helpful although often advocated in guidelines. Although this research comes from an acute settingI think the message carries some relevance for primary care physicians as they try to navigate a path through the potential minefield of chest pain.'