HEART Score for Chest Pain Calculator
Calculate the HEART Score for chest pain in emergency settings.
Stratify risk of major adverse cardiac events (MACE) to guide clinical decision-making.
What Is the HEART Score?
The HEART Score is a clinical risk stratification tool developed in 2008 by Dr. A.J. Six and colleagues in the Netherlands. It is used in emergency departments to predict the likelihood of Major Adverse Cardiac Events (MACE) — defined as acute MI (heart attack), PCI (coronary intervention), CABG (bypass surgery), or death within 6 weeks of a chest pain presentation.
The acronym stands for the five components: History, ECG, Age, Risk factors, and Troponin.
The Five Components
History (0–2): How typical are the symptoms for acute coronary syndrome (ACS)? Crushing or pressure-like chest pain radiating to the arm or jaw (classic angina) scores highest. Atypical or non-cardiac symptoms score 0.
EKG (0–2): A normal EKG (0 points) is reassuring. Non-specific repolarization changes (1 point) include ST depression, T-wave changes, or LBBB not known to be old. Significant ST-segment deviation (2 points) indicates active ischemia.
Age (0–2): Cardiovascular risk rises sharply with age. Under 45 = 0, age 45–65 = 1, over 65 = 2.
Risk factors (0–2): Known cardiovascular risk factors include hypertension, hypercholesterolemia, diabetes, obesity, smoking, and family history of CAD. History of atherosclerotic disease (prior MI, PCI, stroke) scores 2.
Troponin (0–2): Cardiac troponin is the gold-standard biomarker for myocardial injury. Normal or mildly elevated troponin (<= upper limit of normal) = 0. Moderately elevated (1–3× ULN) = 1. Markedly elevated (>3× ULN) = 2.
Score Interpretation
| HEART Score | Risk Category | Approximate MACE Rate |
|---|---|---|
| 0 – 3 | Low risk | ~1.7% |
| 4 – 6 | Moderate risk | ~12% |
| 7 – 10 | High risk | ~65% |
Clinical Use
Low risk (0–3): These patients can often be safely discharged with outpatient follow-up. Multiple studies show the HEART Score is highly effective at identifying patients who can be safely discharged from the emergency department, reducing unnecessary hospitalizations.
Moderate risk (4–6): Observation, serial troponin measurements, and further diagnostic testing (stress test, CT coronary angiography) are typically recommended.
High risk (7–10): Early invasive strategy (cardiac catheterization) is appropriate. These patients require urgent cardiological care.
Comparison to Other Scores
The HEART Score is generally considered more practical than TIMI (Thrombolysis in Myocardial Infarction) for ED risk stratification because it was specifically developed for undifferentiated chest pain patients, not confirmed ACS patients. GRACE score is preferred for prognostication in confirmed ACS.
This tool is strictly for educational purposes. All clinical decisions must be made by qualified medical professionals.