Heart score :A clinical decision rule aimed at the identification of risk in the undifferentiated chest pain, is potentially quite useful as an adjunct to physician medical decision-making &identify patients at low, intermediate, high risk for short-term adverse outcome resulting from Acute coronary syndrome (ACS).
Consist of: History, ECG ,AGE, Risk factors & Troponin
Chest Pain Causes:
Cardiac Causes:Â Â Myocardial ischemia (angina), MI, Myocarditis, Pericarditis, Mitral Value prolapse (MVP), Aortic stenosis, Aortic dissection, Aortic aneurysm.
Non-Cardiac Causes: Â
Emotional: Anxiety, fear, stress.
Gastric Causes: Gerd, Esophagitis and spam, Mallory syndrome.
Pulmonary: Pulmonary embolism, Pulmonary infarct, Pleuritis, pneumonia, pneumonia, pneumothorax, malignancy.
Musculoskeletal: costochondritis, Rib fracture, Rib injury, intercostal muscle injury.
Neurological: Prolapsed intervertebral disc, Herpes zoster, Thoracic outlet syndrome, intercostal neuralgia (especially in diabetic).
Non-Ischemic pian:
- Pleuritic pain, location Mid or lower abdomen, Discomfort localize finger.
- Constant pain lasting for days, fleeting pains lasting for a few second or less and pain radiating into the lower extremities.
Anamnesis
- Highly suspicious (Specific history for ACS) ----------2
- Moderately suspicious (Mixed historic: ACS & Non-ACS)------1
- Slightly suspicious (Nonspecific history for ACS)--------0
ECG
- Significant ST-deviation------2
- Non-specific repolarization disturbance /LBBB/PM-----1
- NORMAL--------1
AGE
- Greater 65 Years-----2
- 45-65 Years ---------1
- less than 45 Years -----0
Risk factors
- 3 Risk factors or history of atherosclerotic disease ------2
- 1 or 2 Risk factor ------1
- Non Risk factors known -------0
Troponin
- Elevate: > 3 time noraml limit -----2
- Elevated: 1-3 time normal limit -------1
- less noraml limit-----------0
Overall health score| Total health score
- Risk category & recommended management strategy.
- 0-3: low risk: potential candidate foe early discharge.
- 4-6:moderate risk: potential candidate for observation & future evalutaion.
- 7-10: high risk: candidate for urgent or emergent intervention.