Contemporary SE has excellent feasibility and positive predictive value and resulted in appropriate risk stratification of symptomatic patients with significant obesity. A normal SE portends an excellent outcome over the short-intermediate term in this high-risk patient population.

In this first randomized study, ESE was more efficacious and demonstrated superior cost-saving, compared with ExECG when used as the initial investigation for the evaluation of CAD in patients with new-onset suspected SA without known CAD.

Chest pain is one of the most frequent reasons for presentation to the Emergency Department. The possible causes of chest pain are numerous and diverse, but importantly, several conditions, such as acute coronary syndrome, pulmonary embolism and aortic dissection, require urgent management and, in some cases, may be life-threatening. In such situations, a prompt and accurate diagnosis is vital. Two-dimensional echocardiography is a safe, painless and rapid test that can be performed in the Emergency Department and ensure a correct diagnosis as well as identify other complications and help institute appropriate management strategies swiftly. We review the current indications for urgent echocardiography in this article, with reference to international management guidelines where available, when managing patients with suspected acute coronary syndrome, acute pulmonary embolism, acute aortic dissection, acute pericarditis and trauma. We also discuss the differences between comprehensive and FOcussed Cardiac UltraSound (FOCUS) echocardiography studies, along with the associated quality control and medicolegal implications.