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In a busy ED, evaluation of chest pain suggestive of myocardial ischaemia needs to cater to early identification of acute coronary syndrome (ACS), limit over investigating patients for low or intermediate probability of ACS and appropriate decision making for discharge, to reduce ED over boarding. Validated scores for evaluating the low or intermediate probability chest pain like the HEART pathway may miss such rare diagnoses in the absence of ECG changes, requiring high degree of suspicion and individualisation of patient care.<\/jats:p>","DOI":"10.1136\/bcr-2022-249065","type":"journal-article","created":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T11:53:57Z","timestamp":1648814037000},"page":"e249065","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Rupture of sinus of Valsalva aneurysm: a rare cause of acute ischaemic chest pain in the emergency department"],"prefix":"10.1136","volume":"15","author":[{"given":"Himanshi","family":"Baid","sequence":"first","affiliation":[{"name":"Emergency Medicine, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nagasubramanyam","family":"Vempalli","sequence":"additional","affiliation":[{"name":"Emergency Medicine, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krishna","family":"Shukla","sequence":"additional","affiliation":[{"name":"Emergency Medicine, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reshma","family":"Asokan","sequence":"additional","affiliation":[{"name":"Emergency Medicine, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,4,1]]},"reference":[{"key":"2025082708505350000_15.4.e249065.1","first-page":"1","article-title":"National Hospital ambulatory medical care survey: 2007 emergency department summary","volume":"26","author":"Niska","year":"2010","journal-title":"Natl Health Stat Report"},{"key":"2025082708505350000_15.4.e249065.2","first-page":"1","article-title":"Emergency department visits for chest pain and abdominal pain: United States, 1999-2008","volume":"43","author":"Bhuiya","year":"2010","journal-title":"NCHS Data Brief"},{"key":"2025082708505350000_15.4.e249065.3","doi-asserted-by":"crossref","unstructured":"Benjamin EJ , Blaha MJ , Chiuve SE , et al . 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