A study of 55 patients over a three-month period who were admitted to the coronary care unit of a large university teaching hospital indicated that, despite the well-documented importance of recognising and treating cardiac chest pain, of the 80% of patients who experienced pain or discomfort, 19% delayed in reporting 'chest pain' for more than 20 minutes and 4% failed to report their 'chest pain' at all. Non-reporting of symptoms was felt to be caused by lack of nursing and medical awareness that this problem existed, lack of patient awareness of the need to report all symptoms and difficulties in communication between nursing staff and patients.