HEART Score for Major Cardiac Events

Predicts 6-week risk of major adverse cardiac events (MACE).

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Parameters

History*

Highly suspicious

Moderately suspicious

Slightly or non-suspicious

EKG*

Significant ST depression

Nonspecific repolarization disturbance

Normal

Age*

≥ 65 years

45-64 years

< 45 years

Risk Factors (HTN, DM, active smoking, fam hx, obesity, hypercholesterolemia)*

≥ 3 risk factors or hx of atherosclerotic disease

1 or 2 risk factors

No known risk factors

Initial Troponin*

≥ 3x normal limit

1–3x normal limit

≤ normal limit

HEART Score for Major Cardiac Events Result

FormulaSum of points from History (0-2), EKG (0-2), Age (0-2), Risk Factors (0-2), and Troponin (0-2)

Clinical Pearls

The HEART score was specifically developed for ED patients with chest pain. It successfully stratifies a large proportion of patients into a low-risk group where early discharge without provocative testing is considered safe.

Limitations

The "History" component is subjective and inter-rater reliability can vary. It should not be used if the patient has STEMI or a clear non-cardiac cause of chest pain.

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