Screening and diagnosis

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Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The INTERCHEST clinical prediction rule is a diagnostic tool used in primary care settings to evaluate patients presenting with chest pain. The name "INTERCHEST" is an abbreviation derived from the study "International Chest pain prediction rule" which developed this tool. 

This calculator is specifically designed for adult patients who present to primary care with chest pain. Its primary clinical utility is to help clinicians estimate the probability of coronary artery disease (CAD) in these patients. By considering various patient characteristics and symptoms, the INTERCHEST rule provides a score that can predict the likelihood of CAD, thereby aiding in decision-making about further diagnostic testing and management.

The INTERCHEST rule should not be used in patients with known CAD, those with a clear alternative diagnosis for their chest pain, or those with chest pain due to trauma. It is also not intended for use in emergency settings, where more acute causes of chest pain (such as myocardial infarction) need to be ruled out.

INTERCHEST clinical prediction rule for chest pain in primary care

# Criteria
 A. Male >= 55 years or female >= 65 years (+1)
B. History of coronary artery disease (+1)
C. Physician initially suspected a serious condition (+1)
D. Chest discomfort feels like "pressure" (+1)
E. Chest pain related to effort (+1)
F. Pain reproducible by palpation (-1)

# Conditions
- score <= 1
- score >= 2
- score == 0

The HEART Score for Chest Pain is a clinical calculator used in the evaluation of patients presenting with chest pain in the emergency department. The acronym HEART stands for History, ECG, Age, Risk Factors, and Troponin, which are the five elements used to calculate the score. 

This scoring system is designed to stratify risk in patients with chest pain, helping clinicians to decide whether a patient can be safely discharged, requires further diagnostic testing, or needs immediate intervention. It is particularly useful in identifying patients at low risk of major adverse cardiac events within the next six weeks.

There are no specific exclusion criteria for the use of the HEART Score, but it should be noted that it is not designed to replace clinical judgment. It should be used as a tool to aid decision-making in conjunction with a thorough clinical assessment.

HEART score for chest pain

# Criteria
 ## Age
A. >= 65 years (+2)
B. 45-65 years (+1)
C. < 45 years (+0)
## Risk factors
D. >= 3 risk factors or history of atherosclerotic disease (+2)
E. 1-2 risk factors (+1)
F. No risk factors known (+0)
## History
G. Highly suspicious (+2)
H. Moderately suspicious (+1)
I. Slightly suspicious (+0)
## Electrocardiogram
J. Significant ST depression (+2)
K. Nonspecific repolarization disturbance (+1)
L. Normal (+0)
## Troponin
M. > 2× normal limit (+2)
N. 1-2× normal limit (+1)
O. <= normal limit (+0)

# Conditions
- score == 0
- score == 1
- score == 2
- score == 3
- score == 4
- score == 5
- score == 6
- score == 7
- score == 8
- score == 9
- score == 10

The Emergency Department Assessment of Chest Pain Score (EDACS) is a clinical calculator used in the emergency department setting to stratify the risk of patients presenting with chest pain. It is specifically designed to identify patients at low risk of major adverse cardiac events (MACE) within 30 days, who are safe for early discharge without further diagnostic testing. 

The EDACS applies to adult patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome. It incorporates variables such as age, sex, risk factors for coronary artery disease, duration of pain, pain characteristics, and initial ECG changes to generate a score. 

The clinical utility of the EDACS is to aid in the safe and efficient disposition of patients in the emergency department, reducing unnecessary admissions and investigations, and improving patient flow. 

Exclusion criteria for the use of EDACS include patients with obvious non-cardiac causes of chest pain, known coronary artery disease, or those who are hemodynamically unstable.

Emergency Department Assessment of Chest Pain Score (EDACS)

# Criteria
 ## Age (years)
A. 18-45 (+2)
B. 46-50 (+4)
C. 51-55 (+6)
D. 56-60 (+8)
E. 61-65 (+10)
F. 66-70 (+12)
G. 71-75 (+14)
H. 76-80 (+16)
I. 81-85 (+18)
J. >= 86 (+20)
## Gender
K. Male (+6)
L. Female (+0)
## Known coronary artery disease (acute myocardial infarction, coronary artery bypass graft, or percutaneous intervention) or >= 3 risk factors (dyslipidemia, diabetes, hypertension, current smoker, family history of premature coronary artery disease); only for patients aged 18-50 years
M. Yes (+4)
N. No (+0)
# Symptoms and signs
O. Diaphoresis (+3)
P. Chest pain radiating to arm or shoulder (+5)
Q. Chest pain occurring or worsening with inspiration (-4)
R. Chest pain reproduced by palpation (-6)
## New ischemia on electrocardiogram
S. Yes (+16)
T. No (+0)
## Troponins (initial and 2-hour)
U. Both negative (+0)
V. Either positive (+16)

# Conditions
- score < 16
- score >= 16
- score == 0

The NYHA functional classification for heart failure, or New York Heart Association Functional Classification, is a scoring system used to quantify the severity of symptoms in patients with heart failure. This classification system is applicable to patients diagnosed with heart failure and is used to assess their functional capacity and limitations during physical activity. 

The NYHA classification is divided into four classes: Class I (no symptoms and no limitation in ordinary physical activity), Class II (mild symptoms and slight limitation during ordinary activity), Class III (marked limitation in activity due to symptoms, even during less-than-ordinary activity), and Class IV (severe limitations, experiences symptoms even while at rest).

The clinical utility of this calculator is to guide treatment decisions, assess prognosis, and evaluate the effectiveness of therapeutic interventions in patients with heart failure. It is also commonly used in clinical trials to stratify patients and measure outcomes. 

There are no specific exclusion criteria for its use, but it is subjective and relies on patient self-report, so it may not be as accurate in patients with cognitive impairment or communication difficulties.

NYHA functional classification for heart failure

# Criteria
 ## Physical ability
A. Patients with cardiac disease, but without limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea.
B. Patients with cardiac disease resulting in slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.
C. Patients with cardiac disease resulting in marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain.
D. Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure at rest, if any physical activity is undertaken, discomfort increases.

# Conditions
- A
- B
- C
- D
- true

Chest pain

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Diagnostic investigations

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Follow-up and surveillance

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