Marburg Heart Score (MHS)

• When evaluating patients with chest pain in primary care, MHS ≤2 means the chest pain is highly unlikely to be due to unstable CAD (negative predictive value ~98%) and further outpatient evaluation is generally safe and appropriate.
• A primary care patient with a MHS ≤2 generally does not need urgent evaluation of chest pain (unless there is clear evidence of clinical instability) and further evaluation, including chest x-ray and stress testing, may be done through non-urgent outpatient follow-up.
• A primary care patient with a MHS ≥3 does not necessarily have unstable CAD, but since unstable CAD cannot be excluded, such patients generally warrant more urgent evaluation or inpatient admission.

• For any primary care patient with chest pain, clinical stability can quickly be determined by evaluating the ABCs (airway, breathing, circulation).
• A patient who shows no signs of respiratory distress and has appropriate vital signs is unlikely to be acutely unstable and can be further evaluated in the office with appropriately targeted history, physical examination, and testing.
• If there is a readily apparent cause of chest pain other than CAD (e.g. trauma, infection), attention should be directed to these causes.
• If there are clearly anginal equivalent symptoms (e.g. jaw pain, dyspnea on exertion, arm pain), or if there are ischemic changes on EKG, then the MHS does not apply and urgent inpatient admission is warranted.

No decision rule should trump clinical gestalt, and any patient with chest pain who is clinically unstable (respiratory distress or abnormal vital signs) warrants urgent or emergency inpatient admission.