01 / ADAPTABLE OUTLINE
What to document
Presentation & risk
Onset and time course, character, radiation, exertional or pleuritic features, associated symptoms, cardiac and thromboembolic risks, and history source.
Examination & initial tests
Record vitals and relevant cardiopulmonary, vascular, chest-wall, and other findings. Document ECG interpretation, troponin assay, values, timing, and reference limits.
Differential & risk assessment
Explain concern for ACS and other dangerous causes. If appropriate, record each HEART component and how it fits the institution's validated pathway.
ED course & disposition
Actual treatments with dose, route and time, response, repeat examinations or tests, consultations, pending results, and admission or discharge reasoning.
02 / WORKED EXAMPLE
An interim ED note — evaluation is still in progress
Illustrative documentation only. Not patient data, a treatment protocol, or a complete billing checklist.
Presentation
A 54-year-old patient presents with intermittent chest pressure. Hypertension is the only identified HEART risk factor. The clinician rates the history moderately suspicious. The patient is currently comfortable, with stable recorded vitals, clear lungs, and regular heart rhythm.
Initial tests & assessment
Initial ECG is normal. The initial troponin is at or below the assay upper reference limit. HEART components are history 1, ECG 0, age 1, risk factors 1, troponin 0: total 3/10, low score range. ACS evaluation is not complete. Pulmonary embolism, acute aortic syndrome, pneumothorax, and noncardiac causes were considered based on the presentation.
ED plan
Continue evaluation under the institutional assay-specific chest-pain pathway, including repeat testing where required by symptom timing and the pathway. Document any indicated treatment and reassess symptoms and examination. Final disposition is pending; neither the initial troponin nor HEART score alone is used to authorize discharge.
A common documentation question
Does a HEART score of 3 mean the patient can be discharged?
Not by itself. The decision depends on the complete assessment, ECG, troponin pathway and timing, other diagnoses, clinical stability, follow-up, and clinician judgment.
03 / CLINICAL REASONING
Differential & testing considerations
Examples to consider—not diagnoses to automatically include in a note.
Differential
- Acute coronary syndrome
- Pulmonary embolism
- Acute aortic syndrome
- Pneumothorax, pericardial disease, and other cardiopulmonary causes
- Chest-wall, esophageal, or other causes after appropriate assessment
Testing & assessment
- Document ECG interpretation and troponin values with collection times and the assay reference limit.
- Use a validated assay-specific clinical pathway for serial testing when indicated.
- Select additional imaging and tests from the actual differential rather than ordering a blanket panel.
04 / TREATMENT & DOSAGE REFERENCES
Make the plan specific.
Selected adult references, not a complete protocol or individualized prescription. Check the indication, formulation, allergies, pregnancy, renal/hepatic function, interactions, and current local guidance. Sources checked September 10, 2026.
Diagnosis-directed emergency treatment
Document only interventions actually given, including the indication, dose, route, timing, response, and contraindication review. There is no universal medication bundle for undifferentiated chest pain. Do not delay emergency treatment for STEMI, instability, or another time-critical diagnosis to complete a score.
AHA/ACC: chest pain evaluation guideline ↗TRY AN INTERACTIVE EXAMPLE
HEART score, with the reasoning visible.
Select inputs, see the score, and preview the documentation. Missing answers stay incomplete.