With the arrival of point-of-care cardiac marker determination, emergency physicians may be able to arrive at the diagnosis of cardiac ischemia faster than ever before. However, these tests must be used with care, as a lack of understanding about when and how they should be obtained is important both for good patient care and to avoid medicolegal pitfalls. This report reviews risk stratification of patients who present with chest pain, provides an overview of cardiac markers and literature supporting their use, and concludes with a practice guideline for the utilization of cardiac markers in the emergency department.