Chest pain can be caused by multiple pathologies. Therefore, the initial priority in the evaluation of a patient with chest pain should be to detect signs of vital compromise and serious pathology that requires urgent action. Among the causes of cardiovascular origin, acute coronary syndrome (ACS), aortic syndrome and acute pulmonary embolism are particularly relevant due to their frequency or potential severity, so the initial diagnostic effort should be aimed at ruling out these pathologies. However, the initial tests are not always going to be conclusive and algorithms are therefore required to accurately rule out or detect patients at high risk of presenting ACS, with the aim of starting a specific treatment when indicated, avoiding unnecessary hospitalizations and inappropriate discharge. Algorithms based on the determination of highly sensitive troponin have gained great relevance and are very useful in this context.