Background: Chest pain is the most presented complain to the emergency departments worldwide. The high rate of mortality and morbidity and the wide variety of its causes increase the burden on physicians and health organizations. Accurate workup and guidance is required in managing these patients in ER. Many life-threatening conditions are simply presented with chest pain, making the ER role crucial to achieve the exact diagnosis and determine further treatment steps. Objectives: In this review, we aim to assess acute chest pain presentation in an emergency department and provide a summarized, yet comprehensive paper. Methodology: PubMed database was used for articles selection using the keywords Chest Pain, Diagnosis, and Management. Conclusion: Acute chest pain can arise as a result of different etiologies, such as ischemic heart diseases, pneumonia, heart failure and pulmonary embolism. The role of emergency physician during the initial evaluation is to rule out ischemic heart diseases and assess if the condition needs further evaluation and testing. The physician should assess the patient characteristics, risk factors and 12 lead ECG that can help in ruling out ischemic heart diseases. When other diagnosis is suspected, the physician should evaluate the related signs and symptoms in order to confirm the diagnosis.