Background: Acute myocardial infarction and ischemic cardiac conditions are one of the most difficult situations emergency physician has to deal in view of exercising clinical decisions regarding admission or discharge from the emergency department. Ischemic Modified Albumin (IMA) is a laboratory test that measures the level of modified albumin in the blood. Albumin is a protein produced by the liver and plays a crucial role in carrying various substances in the bloodstream, such as hormones, drugs, and fatty acids. Aim: The present study was conducted to assess ischemia modified albumin (IMA) as a novel marker in ischemic heart disease. Materials & Methods: 74 cases of ischemic heart disease of both genders was recorded. ST-segment elevation myocardial infarction (STEMI) was diagnosed if there was ST segment elevation >0.1mv in 2 or more contiguous leads with cardiac troponin (cTnT) >0.05ng/ml; non-ST-segment elevation myocardial infarction (NSTEMI) was diagnosed if EKG did not show ST-segment elevation and troponin (cTnT) was >0.05ng/ml. Estimation of ischemic modified albumin (IMA) and TnT was done. Results: Out of 74 patients, males were 40 and females were 34. The mean IMA and TnT level in 15 cases of COPD asthma was 95.1 and 0.0118, 20 cases of CAD was 97.2 and 0.054, in 12 cases of GERD Gastritis was 101.8 and 0.035, 6 cases of pneumonia was 97.2 and 0.017, in 2 cases of TIA stroke was 99.4 and 0.01, in 8 cases of anemia was 93.2 and 0.02, in 6 cases of sepsis was 142.9 and 0.014 and in 4 cases of pancreatitis was 102.7 and 0.22 respectively. The difference was significant (P< 0.05). Hospitalization < 5 days was seen in 60, 5-9 days in 8 and >10 days in 4 patients. Readmission was seen in 8. Interventions done was stress in 7, Echo in 8 and CT A (angio) in 4 patients. The difference was significant (P<0.05). Conclusion: Ischemia-modified albumin may be utilized as a novel marker of ischemia to rule out acute coronary syndrome along with troponin and electrocardiogram in the emergency departments.