ACS is a common and potentially lethal problem. However, only about 10% of patients who present to an emergency department with chest pain actually have ACS. In this JAMA Clinical Reviews podcast, we discuss which signs, symptoms and tests used to make the diagnosis of ACS are reliable. Edward H. Livingston MD, speaks with Alexander Fanaroff, MD, author of Does This Patient With Chest Pain Have Acute Coronary Syndrome? The Rational Clinical Examination Systematic Review as well as a patient who was diagnosed with myocardial infarction.