Algorithm
Hover links for details.
Background
Please note the CUH ED HEART pathway is a risk-stratification tool and does not replace sound clinical judgement.
HEART pathway details
HEART History
High risk:- Middle or left side
- Heavy chest pain
- Sweat / nausea / vomit
- Exertional
- Relief with nitrates
- Well localised
- Sharp pain
- Non-exertional
- No sweating
- No nausea
HEART ECG
New ischaemic changes = 2 points:- Ischaemic ST-segment ↓
- New ischaemic T wave inversion
- Repolarization abnormalities
- Non-specific T wave changes
- Non-specific ST-segment ↓ or ↑
- BBB
- LVH
- Early repolarization
- Digoxin effect
HEART Risk Factors
- ↑Cholesterol
- ↑BP
- Diabetes
- Smoking
- +ve FHx
- Obesity
Troponin levels CUH
- Normal male: less than 34ng/L
- Normal felmale: less than 16ng/L
Evidence/Links
- Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Netherlands Heart Journal 2008; 16(6): 191-196.
- Backus BE, Six AJ, Kelder JC, Mast TP, van den Akker F, Mast G, Monnink SHJ, van Tooren RM, Doevendans PAFM. Chest Pain in the Emergency Room: A Multicenter Validation of the HEART Score. Critical Pathways in Cardiology 2010; 9(3): 164-169.
- Backus BE, Six AJ, Kelder JC, Bosschaart MAR, Mast EG, Mosterd A, Veldkamp RF, Wardeh AJ, Tio R, Braam R, Monnink SHJ, van Tooren R, Mast TP, van den Akker F, Cramer MJM, Poldervaart JM, Hoes AW, Doevendans PA. A prospective validation of the HEART score for chest pain patients at the emergency department. International Journal of Cardiology 2013; 168(3): 2153-2158.
- Mahler SA, Riley RF, Hiestand BC, Russell GB, Hoekstra JW, Lefebvre CW, Nicks BA, Cline DM, Askew KL, Elliott SB, Herrington DM, Burke GL, Miller CD. The HEART Pathway Randomized Trial: Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge. Circulation: Cardiovascular Quality and Outcomes 2015; 9(6): 195-203.
- Radecki RP. New Decision Instruments That Predict Risk of Thrombolysis in Myocardial Infarction May Make TIMI Score Obsolete. ACEP Now 2014; 33(4): 24. http://www.acepnow.com/wp-content/uploads/2014/04/ACEP_April_Final1.pdf (accessed 28 November 2016).
- Reazie S. SGEM#151: Groove is in the HEART Pathway. http://thesgem.com/2016/04/sgem151-groove-is-in-the-heart-pathway/ (accessed 28 November 2016).
- Orman R. Amal Mattu on Low Risk Chest Pain. http://blog.ercast.org/amal-mattulow- risk-chest-pain/ (accessed 28 November 2016). Emergency Department HEART Pathway.
- Print vesions of CUH HEART pathway and shared decision patient information.