HEART Score for Chest Pain Calculator

What Is the HEART Score?

The HEART Score is a risk stratification tool published in 2008 by Dr. A.J. Six and colleagues in the Netherlands. Emergency departments use it to estimate the chance of MACE (Major Adverse Cardiac Events), meaning acute MI (myocardial infarction, a heart attack), PCI (percutaneous coronary intervention, a stent), CABG (coronary artery bypass graft surgery), or death within six weeks of a chest pain presentation.

The acronym is the five components: History, ECG (electrocardiogram, also written EKG), Age, Risk factors, and Troponin. Each scores 0, 1 or 2, so the total runs 0 to 10.

The Five Components

History (0-2): How typical are the symptoms for ACS (acute coronary syndrome)? Crushing or pressure-like chest pain radiating to the arm or jaw, brought on by exertion and eased by rest, is the classic picture and scores 2. Sharp, positional, or reproducible-on-palpation pain scores 0. This is the one genuinely subjective component, and it is where inter-rater agreement is weakest.

ECG (0-2): A normal tracing scores 0. Non-specific repolarisation disturbance scores 1, which covers T-wave changes, LBBB (left bundle branch block), a paced rhythm, LVH (left ventricular hypertrophy) with strain, and digoxin effect. Significant ST-segment deviation scores 2, and that means deviation not explained by any of the 1-point findings above. ST depression belongs in the 2-point row, not the 1-point row, unless it is attributable to bundle branch block, hypertrophy or digoxin.

Age (0-2): Under 45 scores 0, 45 to 64 scores 1, 65 and over scores 2.

Risk factors (0-2): The counted factors are hypertension, hypercholesterolaemia, diabetes, obesity with a body mass index over 30, current or recent smoking, and a family history of CAD (coronary artery disease) in a first-degree relative, before 55 in a man or 65 in a woman. None scores 0, one or two scores 1, three or more scores 2. A history of atherosclerotic disease, meaning a prior heart attack, stent, bypass, stroke or peripheral artery disease, scores 2 on its own regardless of how many other factors are present.

Troponin (0-2): At or below the upper limit of normal scores 0. One to three times the limit scores 1. Above three times scores 2. Note that “normal” means the assay’s own cutoff, and a high-sensitivity assay will call things abnormal that an older assay would have missed, which shifts scores upward compared with the original validation.

Score Interpretation

Rates below are from the Backus multicentre validation, 2,440 chest pain patients in the Netherlands, 2013.

Other cohorts land in the same shape but not on the same numbers, and the high-risk figure in particular ranges from roughly 50% to 65% depending on the population and the troponin assay used. Treat the three bands as the finding; treat the decimals as approximate.

Clinical Use

Low risk (0-3): Often dischargeable with outpatient follow-up. This is the band the score was built to identify, and it is the reason the tool spread: a 1.7% event rate is low enough that most protocols accept it, and admitting these patients turns out not to change their outcomes.

Moderate risk (4-6): Observation, serial troponins, and further testing such as a stress test or CT coronary angiography.

High risk (7-10): An early invasive strategy is appropriate, with urgent cardiology involvement.

One caveat that matters more than the arithmetic: the score assumes the working diagnosis is possible ACS. It has nothing to say about aortic dissection, pulmonary embolism, or oesophageal rupture, and a low HEART Score on a patient whose real problem is a dissection is a low score on the wrong question.

Comparison to Other Scores

HEART is generally more practical than TIMI (Thrombolysis in Myocardial Infarction) for emergency department triage because it was built on undifferentiated chest pain rather than on patients already known to have ACS. GRACE (Global Registry of Acute Coronary Events) is the better choice for prognosis once ACS is confirmed.

This tool is strictly for educational purposes. All clinical decisions must be made by qualified medical professionals.