Chest pain in the intensive care unit (ICU) is a critical symptom that demands a swift and systematic approach to identify potentially life-threatening conditions. Differentiating between cardiac and noncardiac causes is of paramount importance, and utilizing structured assessment tools can significantly enhance diagnostic accuracy. The pain can be visceral or somatic. Visceral pain is usually dull and over a larger area without any localization; whereas somatic pain is usually sharp, stabbing, and localized to a specific spot/area (dermatomal distribution). Importantly, clinicians must recognize that chest pain presentations can vary across different populations. Women, for instance, may experience symptoms beyond chest pain, such as nausea, fatigue, or shortness of breath, which can lead to underdiagnosis. Older adults often present with atypical symptoms like shortness of breath or confusion rather than chest pain alone. This chapter presents a comprehensive algorithm for evaluating chest pain in the ICU, incorporating current international guidelines, risk stratification methods, and considerations for diverse populations to ensure prompt and appropriate management [1, 2]. [Ref: Algorithm 62.1].