In the clinic, we often encounter patients with chest pain who visit the clinic and ask with great anxiety whether their symptoms are due to coronary artery disease and whether they need coronary angiography. They have been perplexed by this question for a long time, sometimes taking many detours that even affect their lives. Here I will briefly explain and update appropriately at the right time, and I hope it will be of some help to you. First, the vast majority of patients who qualify for typical angina have at least one major coronary artery stenosis greater than 70%. The so-called typical angina needs to meet the following points, rather than plausible or just one or two: (1) appearing after activity, not at rest after activity; (2) lasting 3 to 5 minutes, rarely more than 30 minutes; (3) chest tightness or chest pain behind the sternum, more likely if accompanied by tightness in the throat, breathlessness, presence of left arm or teeth radiation; (4) rest A few minutes (usually 3 to 5 minutes) can relieve it; or take nitroglycerin or heart pills for 3 to 5 minutes to relieve it. If all of them are met, it is recommended to have an imaging sooner; if 3 items are met, coronary artery disease is very likely. What if only two items are met? This is atypical chest pain and needs to be seen by an outpatient clinic and judged by a doctor. If the chest pain turns from typical to atypical, the possibility of myocardial infarction is greatly increased, and early hospitalization for examination is recommended. Some patients visit the clinic with special emphasis on chest pain when they have an attack with heavy sweating all over their body and their clothes are soaked through, which is a very dangerous sign and needs to be seen as soon and as early as possible. If the nature of the chest pain is more similar to the original angina attack, there is a greater risk of myocardial infarction; if the chest pain resembles a knife cut or is very violent and tear-like, it may be aortic coarctation, especially in patients who originally had high blood vessels and whose blood pressure is poorly controlled. In patients who have already had coronary angiography and stent implantation, if chest pain occurs again, especially if the chest pain is relatively similar to that of the last offense when the stent was implanted, then the diagnosis of coronary angina is very likely and another admission for coronary angiography is needed. However, the clinical symptoms of patients are sometimes very varied and complex, and not every patient is so typical. If they were all so typical, there would be no need for patients to see an outpatient clinic, and a robot could be invented to solve the diagnosis of all diseases. So how are those patients with atypical chest pain diagnosed? The vast majority of chest pain related to limb activity is likely to be referred pain, especially chest pain due to arm abduction, or chest pain due to changing positions, such as turning over or rotating the body at night, which is mostly not angina and is more likely to be muscle pain. However, if the chest pain is caused by holding heavy objects in the limbs, such as chest pain caused by carrying things, or chest pain caused by lifting heavy objects, it may be angina pectoris, which is coronary heart disease and needs to be clarified by imaging, which also requires outpatient consultation. Most of the stabbing or sharp pains are not angina pectoris, especially if the pain is very short, not more than one or two seconds, most of them are neuralgia, which is more common in young patients and usually do not require consultation; if the stabbing or sharp pains are longer or persistent, you need to be alert to the possibility of herpes zoster. However, a very small number of patients have angina pectoris, which requires a physician’s judgment, especially in patients with more risk factors for coronary artery disease (e.g., patients with coexisting risk factors such as hypertension, diabetes, hyperlipidemia, and smoking). The second is stuffy pain, especially if it is related to weather changes and lasts for a very long time. The vast majority of this chest pain is not angina pectoris, and in female patients in their 50s, it is mostly likely to be due to menopause, and generally does not require medical attention. There is also pressure pain in the chest, especially in the rib cage, which may be due to inflammation or other causes, not angina pectoris, and usually does not need to be seen in the cardiology clinic, but can be seen in the thoracic surgery department. Some patients visit the clinic with simple back pain or simple scapular pain, and the back and scapular pain is not fixed, lasts for a long time, and is not much related to activity, in this case most of them are not related to coronary heart disease. Other patients complained of irregular location of chest pain when they visited the clinic, one moment behind the sternum, one moment on the left side, one moment on the right side, sometimes under the sword, sometimes in the throat, in this case most of them are also not angina pectoris. The purpose of gastroscopy is to exclude gastrointestinal diseases, because in some patients, gastric disease and coronary heart disease may coexist.