Chest Pain: Calculating my risk

By |April 27th, 2020|Angina, Blog|0 Comments

 

One of the most worrying things when we experience chest discomfort is the possibility that it can be due to heart disease and that it could be a warning for something really bad on the horizon such as a heart attack or even death. 

Chest pain can be due to so many different pathologies and not all forms of chest pain indicate a problem with the heart and therefore a lot of people ignore it and decide that they would wait and see if it becomes more problematic before seeking help – the only problem with that approach is that next episode could be the actual heart attack – so if there were a way of gauging our overall risk when we experience chest pain then it may help us decide to go and seek help as soon as possible. 

This is where the HEART score comes in

HEART is an acronym for: 

  1. History
  2. EKG
  3. Age
  4. Risk factors
  5. Troponin

 

Each of these can be scored from a value of zero to two.

Let’s go through each of these:

History:

If the history is not particularly suspicious or only slightly suspicious, it is given a score of zero

If it is moderately suspicious, give it a score of 1

If it is highly suspicious, give it a score of 2

 

EKG:

If it normal, it gets zero

If it is abnormal with only mild changes, it gets a score of 1

If it is abnormal with major changes (ST depression), it gets a score of 2

 

Age:

<45y – 0

45-64 -1

>64 – 2

 

Risk factors

High BP, diabetes, high cholesterol, excessive body mass index, Smoking, a positive family history, prior heart attacks, stents or bypasses and peripheral artery disease

If no risk factors: zero

If 1-2 risk factors : 1

If >=3 risk factors, 2

 

Troponin

If normal – 0

If 1-3x normal – 1

If >3x normal values – 2

 

Then calculate the scores:

If the scores are 0-3, the chances of something bad (such as a heart attack or death) at 6 weeks is between 0.9-1.7%

If the score is 4-6, 12-16.6% risk

If scores are >7, there is a 50-65% risk of something bad happening at 6 weeks.

 

The utility of the HEART score was published in 2018 by Brady et al. (Brady W, de Souza K. The HEART score: A guide to its application in the emergency department. Turk J Emerg Med. 2018;18(2):47–51. Published 2018 Jun 14. doi:10.1016/j.tjem.2018.04.004)

 

So the messages are as follows:

  1. Your overall risk is determined by a combination of your age, your risk factors, blood tests, ECG and the nature of pain
  2. It is therefore a mistake to base your decisions regarding seeking help just on the basis of the nature of pain
  3. Early assessment is crucial because if you leave it several weeks, something bad may already have happened to you by then

I hope you found this useful. 

https://youtu.be/Hyj4Rz1hxTI

Tags: chest pain; risk of heart attack, risk calculator; angina

About the Author:

Dr Sanjay Gupta
I'm Dr Sanjay Gupta, a Consultant Cardiologist with specialist interest in Cardiac Imaging at York Teaching Hospital in York, UK. I believe that high quality reliable jargon-free information about health should be available at no cost to everyone in the world.

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