Background: Three quarters of patients with non-diagnosed chest pain after a normal cardiac evaluation continue to complain from residual pain. By careful history taking and physical examination, number of those patient diagnosed to have musculoskeletal pain. The proper management will help to reduce the socio-economic consequences due to fear and anxiety of undiagnosed coronary artery diseases. Aim: To highlight one of the other differential diagnoses of ischemic chest pain. Patients and Method: Fifty patients with chest pain were involved. All these patient had chronic chest pain and normal all cardiac evaluations. These patients were examined by rheumatologist to reach the final diagnosis. Results: The mean age was 46.6±14 standard deviation. About 40% of the patients were complained from left side chest pain. The final diagnosis was either muscular pain, shoulder problem, cervical radicular pain, costochondritis, or fibromyalgia. Conclusion: Musculoskeletal chest pain is not uncommon and an important differential diagnosis of chest pain for patients presented to cardiac clinic. After exclusion of cardiac causes, a high index of suspension and an appropriate approach is recommended to diagnose and treat these conditions to improve patients' quality of life.