Calculate Heart Score

HEART Score Calculator for Chest Pain

Understanding the HEART Score

The HEART score is a clinical decision support tool used in emergency departments to risk stratify patients presenting with chest pain. It helps clinicians assess the 30-day risk of Major Adverse Cardiac Events (MACE), which include myocardial infarction, revascularization, and death. By combining five key clinical variables, the score provides a rapid and reliable estimate of risk, guiding decisions regarding further investigation, admission, or discharge.

Components of the HEART Score:

• History (H): Assesses the nature and characteristics of the chest pain, specifically its suspicion for cardiac ischemia.
• ECG (E): Evaluates the electrocardiogram for signs of ischemia or infarction.
• Age (A): Older age is a known risk factor for cardiovascular disease.
• Risk Factors (R): Accounts for traditional cardiovascular risk factors such as diabetes, hypertension, dyslipidemia, smoking, and family history of coronary artery disease.
• Troponin (T): Measures the initial cardiac troponin level, a biomarker for myocardial injury.

Scoring System:

Each component is assigned 0, 1, or 2 points based on specific criteria. The total score ranges from 0 to 10 points.

• History:
  • 0 points: Slightly suspicious (non-ischemic)
  • 1 point: Moderately suspicious (possible ischemic)
  • 2 points: Highly suspicious (definite ischemic)
• ECG:
  • 0 points: Normal or non-specific repolarization changes
  • 1 point: Non-specific repolarization disturbance
  • 2 points: Significant ST-segment deviation
• Age:
  • 0 points: < 65 years
  • 1 point: 65-85 years
  • 2 points: > 85 years
• Risk Factors:
  • 0 points: No known risk factors
  • 1 point: 1-2 risk factors
  • 2 points: ≥ 3 risk factors
• Troponin:
  • 0 points: Below Upper Limit of Normal (ULN)
  • 1 point: 1 to 3 times ULN
  • 2 points: Greater than 3 times ULN

Risk Stratification:

The total HEART score correlates with the 30-day risk of MACE:

• 0-3 points (Low Risk): Approximately 1.7% risk of MACE. Patients in this category may often be safely discharged with outpatient follow-up.
• 4-6 points (Intermediate Risk): Approximately 16.6% risk of MACE. These patients typically require further observation, serial troponin measurements, and possibly stress testing.
• 7-10 points (High Risk): Approximately 50.1% risk of MACE. Patients in this category usually require admission, aggressive management, and early invasive strategies.

Example Calculation:

Let's consider a 70-year-old patient presenting with chest pain:

• History: Moderately suspicious (1 point)
• ECG: Non-specific repolarization disturbance (1 point)
• Age: 70 years (1 point, as it's between 65-85)
• Risk Factors: Has hypertension and is a past smoker (2 risk factors = 1 point)
• Troponin: Initial troponin is 2 times ULN (1 point)

Total HEART Score: 1 + 1 + 1 + 1 + 1 = 5 points.

This patient would be classified as Intermediate Risk, suggesting the need for further evaluation and observation.

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