Chest pain is a non-specific complaint and is the most frequent reason for patients seeking urgent medical attention. A small group of these patients will have acute myocardial infarction (AMI). The current diagnostic and triage systems based on clinical history and electrocardiograms are insufficient. They may result in some of these patients being misdiagnosed and being admitted to the wrong units or receiving inappropriate care, treatment and investigations. In some patients, the diagnosis is delayed resulting in the late administration (or no administration) of essential early treatment. A few patients with AMI may be inadvertently discharged from the emergency department leading to serious health and legal implications. These systems also result in the unnecessary admission of a substantial number of patients without ACS. The triage and management of patients with chest pain can be considerably improved by implementation of serial cardiac markers testing that can identify AMI in the very early stages of presentation. This review article will discuss the currently available markers of myocardial damage such as, creatine kinase (CK-MB) , heart-type fatty acid-binding protein, LDH, and cardiac troponin I Heart-type fatty acid binding protein (H-FABP) functions as a myocardial fatty acid transporter and is released into the circulation early after myocardial injury. We hypothesized that( H-FABP) is superior to conventional cardiac biomarkers for its early release kinetics as it released after an hour of the chest pain. The aim of this work was to investigate the role of H-FABP as a cardiac marker in early diagnosis of acute myocardial infarction. The current study was conducted on 62 patients 54 Males and 8 Females with AMI and 32 control. Sex and age matched healthy subjects taken as a control group. The patients divided into two groups (1) and (2) according to the onset of chest pain. Group (1) which less than or equal four hours, Group (2) which is more than four hours. We measure the level of H-FABP,Troponin I,CK-MB,and LDH. In all cases of both groups, we found H-FABP in first group with higher sensitivity than Troponin I because delay release kinetics of Troponin I after 4-6 hours. Commercial H-FABP assays (Randox Immunoturbidimetric Assay) are now capable of rapidly and accurately measuring H-FABP in routine clinical practice and their use is likely to further improve the outcome of patients with ACS. In addition, there is emerging data that the measurement H-FABP may be useful in other clinical settings such as chronic heart failure, pulmonary embolism as well as in the setting of percutaneous coronary intervention and cardiac surgery.