Consecutive patients coming as an emergency with chest pain due to myocardial ischemia or esophageal disease were interviewed on admission to the hospital, before they had been fully investigated. Classical features of angina pectoris were equally common in both groups and “crescendo angina” was often found in patients with esophageal disease. Features that helped to distinguish esophageal from cardiac pain were: 1) an atypical response to exercise, 2) pain that continued as a background ache, 3) retrosternal pain without lateral radiation, 4) pain that disturbed sleep, and 5) the presence of certain esophageal symptoms. A positive diagnosis will be made more often in cases of suspected but unsubstantiated coronary disease by clinicians who are aware that esophageal pain and angina may be indistinguishable.