Utility of the Cardiac Electrical BiomarkerDisease

1. Acute chest pain assessment in the Emergency department Inclusion criteria * Participant is willing and able to give informed consent for participation in the study * Male or Female, aged 18 years or above Exclusion criteria The participant may not enter the study if ANY of the following apply: * Unable or unwilling to give valid consent for participation in the study * Participant has been previously recruited to another module of the VECTRA ECG study * Participant has history of allergy to ECG electrode * Noisy ECG trace in spite of appropriate preparation and elimination of mains artefact and muscle tremor * ECG tracing with a wandering baseline * Sustained or non-sustained ventricular/atrial arrhythmia (Ventricular tachycardia, supraventricular tachycardia, atrial fibrillation, bigeminy and trigeminy) * QRS duration greater than 120 milliseconds * Q waves (except positional Q waves checked by deep inspiration) * Suspected Septicaemia, pulmonary embolism or aortic dissection * Recent history of trauma to thorax * Severe renal impairment with eGFR \<30 ml/min 2. Acute chest pain assessment in the Primary Care Surgery Inclusion criteria * Participant is willing and able to give informed consent for participation in the study. * Male or Female, aged 18 years or above. * Participants who have experienced chest pain more than 6 hours but less than 2 weeks of presentation to the surgery Exclusion criteria The participant may not enter the study if ANY of the following apply: * Unable or unwilling to give valid consent for participation in the study * Participant has been previously recruited to another module of the VECTRA ECG study * Participant has history of allergy to ECG electrode * Participants who have experienced 'Acute chest pain', defined as chest pain occurring less than 6 hours prior to presentation at the surgery * Participants whose initial Electrocardiogram reveals features compatible of ST elevation Myocardial Infarction * Participants whose initial Electrocardiogram reveals a Left Bundle branch block suspected to be of new onset * Noisy ECG trace in spite of appropriate preparation and elimination of mains artefact and muscle tremor * ECG tracing with a wandering baseline * Sustained or non-sustained ventricular/atrial arrhythmia (Ventricular tachycardia, Supraventricular tachycardia, atrial fibrillation, bigeminy and trigeminy) * QRS duration greater than 120 milliseconds * Q waves (except positional Q waves checked by deep inspiration) * Suspected Septicaemia, pulmonary embolism or aortic dissection * Recent history of trauma to thorax * Severe renal impairment with eGFR \<30ml/min 3. Performance of CEB during inducible ischaemia in patients with stable angina Inclusion criteria * Participant is willing and able to give informed consent for participation in the study. * Male or Female, aged 18 years or above. Exclusion criteria The participant may not enter the study if ANY of the following apply: * Unable or unwilling to give valid consent for participation in the study * Participant has been previously recruited to another module of the VECTRA ECG study * Lack of adequate ultrasound acoustic window * Contraindications to undergoing stress test using dobutamine * Participant has history of allergy to ECG electrode * Noisy ECG trace in spite of appropriate preparation and elimination of mains artefact and muscle tremor * ECG tracing with a wandering baseline * Sustained or non-sustained ventricular/atrial arrhythmia (Ventricular tachycardia, supraventricular tachycardia, atrial fibrillation, bigeminy and trigeminy) * QRS duration greater than 120milliseconds * Q waves (except positional Q waves checked by deep inspiration) * Suspected Septicaemia, pulmonary embolism or aortic dissection * Recent history of trauma to thorax * Severe renal impairment with eGFR \<30 ml/min 4. Performance of CEB during acute ischaemia in patients undergoing percutaneous coronary intervention (PCI) Inclusion criteria * Participant is willing and able to give informed consent for participation in the study * Male or Female, aged 18 years or above * Participant diagnosed with stable CAD or stable ACS (unstable angina or NSTEMI with no pulmonary oedema or cardiogenic shock at the time of recruitment) * Participant with Single vessel coronary artery disease or multi- vessel disease for target vessel PCI Exclusion criteria The participant may not enter the study if ANY of the following apply: * Unable or unwilling to give valid consent for participation in the study * Participant has been previously recruited to another module of the VECTRA ECG study * Participant has history of allergy to ECG electrode * Participants known to have multi-vessel coronary artery disease with one or more Chronic Total Occlusive lesions * Severe Left main coronary artery stenosis * Noisy ECG trace in spite of appropriate preparation and elimination of mains artefact and muscle tremor * ECG tracing with a wandering baseline * Sustained or non-sustained ventricular/atrial arrhythmia (Ventricular tachycardia, supraventricular tachycardia, atrial fibrillation, bigeminy and trigeminy) * QRS duration greater than 120 milliseconds * Q waves (except positional Q waves checked by deep inspiration) * Suspected Septicaemia, pulmonary embolism or aortic dissection * Recent history of trauma to thorax * Severe renal impairment with eGFR \<30 ml/min 5. Performance of CEB in patients undergoing cardio-toxic treatment (type 1 and type 2 cytostatic based treatments of haemo-oncological patients Inclusion criteria * Participant is willing and able to give informed consent for participation in the study. * Male or Female, aged 18 years or above. * Participants who have been given a diagnosis of cancer and are being commenced on a chemotherapeutic drug deemed to be cardio-toxic Exclusion criteria The participant may not enter the study if ANY of the following apply: * Unable or unwilling to give valid consent for participation in the study * Participant has been previously recruited to another module of the VECTRA ECG study * Participant has history of allergy to ECG electrode * Participants previously diagnosed with Cardiomyopathy or Heart failure * Lack of adequate ultrasound acoustic window * Noisy ECG trace in spite of appropriate preparation and elimination of mains artefact and muscle tremor * ECG tracing with a wandering baseline * Sustained or non-sustained ventricular/atrial arrhythmia (Ventricular tachycardia, supraventricular tachycardia, atrial fibrillation, bigeminy and trigeminy) * QRS duration greater than 120milliseconds * Q waves (except positional Q waves checked by deep inspiration) * Suspected Septicaemia, pulmonary embolism or aortic dissection * Recent history of trauma to thorax * Severe renal impairment with eGFR \<30ml/min