Chest pain is one of the most common—and highest risk—complaints in the ED. Missing acute coronary syndrome can be catastrophic, but keeping every patient in the hospital isn’t realistic either. That’s why the HEART score has become the standard of care: a simple, validated tool to help you decide who is safe for early discharge and who needs further workup or cardiology assessment.
In this episode, I’ll show you how to remember and apply the HEART score effortlessly by flipping it into the 6 S’s and 6 H’s framework—a diamond-shaped way to risk-stratify chest pain that you can run through in real time, right at the bedside. This method blends the Diamond classification of angina with the HEART score, anchoring it to recall cues you’ll never forget. Once you master the S’s and H’s, you’ll be able to calculate HEART quickly, communicate clearly, and avoid missing high-risk patients.
Of course, always follow your local protocols—but for every chest pain encounter, remember: ALWAYS calculate the HEART score.
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💎 6 S’s & 6 H’s: The Framework
S’s — Symptoms, ECG, Risk factors, Age
Suspicious Symptoms (Diamond criteria)
1 . Substernal
→ Typical angina = 3/3
→ Atypical angina = 2/3
→ Non-anginal = 0–1
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H’s — The Highs & History
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⚠️ Pearls & Pitfalls
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👉 Whether you’re on shift, teaching, or reviewing for boards, this episode makes the HEART score second nature. Save time, reduce misses, and risk stratify chest pain with confidence.