Prompt and accurate identification of patients with acute coronary syndrome (ACS) presenting to the emergency department (ED) is paramount to the success of interventional and therapeutic strategies. Accurate diagnosis of ST-segment elevation myocardial infarction or non-ST-segment elevation myocardial infarction is hindered by atypical presentations and suboptimal diagnostic tools. The current standard of care, 12-lead electrocardiogram, has limited efficacy. It does not allow complete imaging of various anatomic segments of the heart and therefore fails to accurately identify some patients who would benefit from immediate therapy. Body surface mapping (BSM) allows greater spatial representation of cardiac electrical activity than 12-lead electrocardiogram, with a more complete view of cardiac electrophysiology and greater sensitivity for detecting acute myocardial infarction. Recent technological advances have overcome previous limitations of BSM, including the need for extensive training, difficulty interpreting results, and cost. The future of BSM in the ED is not yet known but will be aided by the ongoing large-scale Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction trial (OCCULT-MI) trial, which uses PRIME BSM technology.