Chest pain is a non-specific complaint and is the most frequent reason for patients seeking urgent medical attention. A small group of these patients will have acute coronary syndromes (ACS). The current diagnostic and triage systems based on clinical history and electrocardiograms are insufficient. They may result in some of these patients being misdiagnosed and being admitted to the wrong units or receiving inappropriate care, treatment and investigations. In some patients, the diagnosis is delayed resulting in the late administration (or no administration) of essential early treatment. A few patients with ACS may be inadvertently discharged from the emergency department leading to serious health and legal implications. These systems also result in the unnecessary admission of a substantial number of patients without ACS. The triage and management of patients with chest pain can be considerably improved by implementation of serial cardiac markers testing that can identify ACS in the very early stages of presentation. This review article will discuss the currently available markers of myocardial damage such as creatine kinase (CK), creatine kinase muscle and brain (CK-MB) (mass and activity), CK-MB isoforms, heart-type fatty acid-binding protein, myoglobin, cardiac troponin T, and cardiac troponin I.