Additionally, this guideline addresses the approach to asymptomatic patients with SIHD that has been diagnosed solely on the basis of an abnormal screening study, rather than on the basis of clinical symptoms or events such as anginal symptoms or ACS. The inclusion of such asymptom- atic patients does not constitute an endorsement of such tests for the purposes of screening but is simply an acknowledg- ment of the clinical reality that asymptomatic patients often present for evaluation after such tests have been performed. Multiple ACCF/AHA guidelines and scientific statements have discouraged the use of ambulatory monitoring, treadmill testing, stress echocardiography, stress myocardial perfusion imaging (MPI), and computed tomography (CT) scoring of coronary calcium or coronary angiography as routine screen- ing tests in asymptomatic individuals. The reader is referred to these documents for a detailed discussion of screening, which is beyond the scope of this guideline (Table 3). Patients with known IHD who were previously asymptom- atic or whose symptoms were stable can develop new or recurrent chest pain or other symptoms suggesting ACS. Just as in the case of patients with new-onset chest pain, the clinician must determine whether such recurrent or worsening pain is consistent with ACS or simply represents symptoms more consistent with chronic stable angina that do not require emergent attention. As indicated previously, patients with AMI or moderate- to high-risk UA fall outside of the scope of this guideline, whereas those with chronic stable angina or low-risk UA are addressed in the present guideline. When patients with documented IHD develop recurrent chest pain, the symptoms still could be attributable to another condition. Such patients are included in this guideline if there is sufficient suspicion that their heart disease is a likely source of symptoms to warrant cardiac evaluation. 