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HEART Pathway for Early Discharge in Acute Chest Pain

Slightly suspicious 0
Moderately suspicious 1
Highly suspicious 2
1 point: No ST depression but LBBB, LVH, repolarization changes (ex: digoxin); 2 points: ST depression/elevation not due to LBBB, LVH, or digoxin
Normal 0
Non-specific repolarization disturbance 1
Significant ST depression 2
<45 0
45-64 1
≥65 2
Risk factors
Risk factors: HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m2), smoking (current, or smoking cessation ≤3 mo), positive family history (parent or sibling with CVD before age 65); atherosclerotic disease: prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease
No known risk factors 0
1-2 risk factors 1
≥3 risk factors or history of atherosclerotic disease 2
Initial troponin
Use local assays and corresponding cutoffs
≤normal limit 0
1–2× normal limit 1
>2× normal limit 2


Result Interpretation

Ranges Ranges

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