Patients presenting to the Emergency Department (ED) with chest pain remain a major clinical challenge. In the United States alone there are over eight million annual visits for this problem, resulting in over four million admissions. Nontraumatic chest discomfort remains the primary catalyst for ED evaluation of possible acute coronary syndromes, including unstable angina, non-ST-segment elevation myocardial infarction and ST-segment myocardial infarction. The diagnosis and treatment of congestive heart failure is also critically important to emergency physicians and other healthcare providers. The diagnosis of cerebrovascular disease is equally difficult, with up to one million patients presenting to the emergency department with stroke each year. Therefore, it is essential that emergency physicians remain on the forefront of state of the art diagnostic and treatment options involving the newest regimens for ACS, CHF, and stroke.