This week we discuss an important 'general cardiology' question - namely, do all exertional chest pain patients need an echocardiogram. In this debate from the World Congress of Pediatric Cardiology and Cardiac Surgery, we hear 2 noted authorities in non-invasive imaging. First up is Dr. Carolyn Altman of Texas Children's Hospital taking the stance that it is indicated in the majority and following Dr. Altman is Dr. Kenan Stern of Mount Sinai Kravis Children's Hospital defending the role of discretion in these decisions and how 'one size may not fit all'. Both authorities provide deep insights into general cardiology and the nuances of evaluating a common cardiology complaint seen in general practice.