Chest pain is the most common presenting symptom of coronary heart disease. A structured nursing assessment of the patient's complaint of chest pain must therefore be carried out as it has potential high-risk factors that may require immediate intervention. An effective physical assessment strategy has a beneficial effect on patient management and can reduce mortality rates in coronary disease. An evaluation of the the patient's history can help guide the examining nurse towards accurate diagnoses and, subsequently, the adoption of appropriate treatment. This article presents the use of a systematic approach to the assessment of cardiac patients with chest pain. The combination of a full patient history with a thorough physical examination is the most powerful tool that can be employed, leading to accurate diagnoses.