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SAMIKSHA HEART AND DIABETIC CARE '' CHEST PAIN'' Indications for Echocardiography in Patients with Chest Pain Class I: Evidence or general agreement or both exists that the procedure is useful or beneficial 1. Diagnosis of underlying cardiac disease in patients with chest pain and clinical evidence of valvular, pericardial, or primary myocardial disease 2. Evaluation of chest pain in patients with suspected acute myocardial ischemia, when baseline ECG is nondiagnostic and when study can be obtained during pain or soon after its abatement 3. Evaluation of chest pain in patients with suspected aortic dissection 4. Chest pain in patients with severe hemodynamic instability Class III: Conditions for which evidence and/or general agreement exist that the procedure is not useful/effective 1. Evaluation of chest pain for which a noncardiac etiology is apparent Figure 48–22 2. Diagnosis of chest pain in a patient with electrocardiographic changes diagnostic of myocardial ischemia/infarction Chetlin et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography. Circulation. 1997;95.