According to the 2022 ACC/AHA Chest Pain Guidelines, a patient presenting with possible ACS whose HEART score is 6 (high risk) should be managed as:
- A Discharge with stress testing within 72 hours
- B Observation and serial troponins only
- C Early invasive strategy with coronary angiography ✓
- D Conservative strategy with repeat ECG at 3 hours
Correct answer: C. Early invasive strategy with coronary angiography
Explanation
The HEART score (History, ECG, Age, Risk factors, Troponin) stratifies chest pain patients: 0–3 low risk (safe discharge), 4–6 moderate risk (observation/serial enzymes), 7–10 high risk (early invasive). However, a HEART score ≥6 combined with a high-sensitivity troponin elevation triggers early invasive strategy per 2022 ACC/AHA guidelines. The approach follows the overall NSTEMI pathway where high-risk features mandate coronary angiography within 24 hours. Serial troponins alone are insufficient for HEART score ≥7; early angiography is the standard of care.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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