EKG Compass

Clinical Score Calculators

Validated bedside risk tools — scores update live as you enter values. For educational use; always apply clinical judgement.

ACS
AFib
PE
ECG
CLASSIFY
HEART Score
Risk stratification for chest pain in the ED. Each component scored 0–2; total 0–10.
Validated for 6-week MACE (major adverse cardiac events).
HistoryChest pain character, radiation, diaphoresis, response to nitrates
ECGReview the 12-lead ECG
AgePatient age in years
Risk FactorsHTN, hypercholesterolaemia, DM, obesity (BMI>30), smoking, family history of CAD, atherosclerosis
TroponinCompared to hospital's upper limit of normal (ULN)
HEART Score
0
Low Risk
1.7% 6-week MACE risk
Safe for early discharge
Discharge with outpatient follow-up. No need for urgent intervention.
/ 10 points

Risk Thresholds

0–3 Low risk~1.7% MACE
4–6 Moderate~12–16%
7–10 High risk~50–65%
TIMI Score — UA / NSTEMI
Predicts 14-day risk of all-cause mortality, MI, or urgent revascularisation in unstable angina or NSTEMI. Each item = +1 point; total 0–7.
Age ≥ 65 years
≥ 3 CAD risk factorsFamily history, HTN, hypercholesterolaemia, DM, active smoker
Prior coronary stenosis ≥ 50%Known from prior catheterisation
ST deviation on presenting ECG≥ 0.5mm ST depression or transient ST elevation
≥ 2 anginal events in prior 24 hoursRest angina ≥ 10 min, new-onset angina, or accelerating pattern
Use of aspirin in prior 7 daysSuggests aspirin-refractory disease
Elevated serum cardiac markersTroponin or CK-MB above upper limit of normal
TIMI Score
0
Low Risk
~5% event rate at 14 days
Conservative strategy. Medical management; consider stress testing before discharge.
/ 7 points

14-Day Event Rate

0–2 Low~5%
3–4 Intermediate~13–20%
5–7 High~26–41%
GRACE Score — ACS
Predicts in-hospital and 6-month mortality post-ACS. Uses 8 clinical variables. Score 0–372 (higher = worse).
AgeYears
Heart RateBeats per minute on presentation
Systolic BPmmHg on presentation
Creatininemg/dL (multiply μmol/L by 0.0113)
Killip ClassClinical heart failure classification
Cardiac arrest at admissionVentricular fibrillation or asystole requiring resuscitation
ST deviation on ECGST elevation or depression ≥ 0.5mm
Elevated cardiac markersTroponin or CK-MB above ULN
GRACE Score
—
Enter values
Fill in all fields to calculate in-hospital mortality estimate.
Complete all fields for risk stratification.
Max 372 pts

In-Hospital Mortality

< 109 Low< 1%
109–140 Intermediate1–3%
> 140 High> 3%
CHA₂DS₂-VASc Score
Annual stroke risk in non-valvular atrial fibrillation. Guides anticoagulation decisions. Score 0–9.
Congestive Heart FailureOr LVEF < 40%
HypertensionResting BP > 140/90 or on antihypertensive therapy
Age ≥ 75 yearsScores 2 points (independent of the 65–74 category)
Diabetes MellitusFasting glucose > 125mg/dL or on diabetic therapy
Stroke / TIA / ThromboembolismPrior history — highest independent risk predictor
Vascular DiseasePrior MI, peripheral artery disease, or aortic plaque
Age 65–74 yearsDo not count if ≥ 75 is already checked
Sex Category — FemaleFemale sex adds 1 point; does not independently predict stroke when score = 1
CHA₂DS₂-VASc
0
Low Risk
~0% annual stroke risk
Anticoagulation not recommended. Aspirin alone if patient prefers.
/ 9 points

Annual Stroke Risk

0 (men) / 1 (women)~0%
1 (men)~1.3%
2~2.2%
≥ 33.2–15.2%
HAS-BLED Score
Estimates 1-year major bleeding risk in patients on anticoagulation for AF. Use to identify and correct modifiable risk factors — NOT to withhold anticoagulation.
Hypertension (uncontrolled)Systolic BP > 160 mmHg
Renal dysfunctionDialysis, transplant, or creatinine > 2.26 mg/dL (200 μmol/L)
Liver dysfunctionCirrhosis, bilirubin > 2× ULN, or AST/ALT/ALP > 3× ULN
Stroke historyPrior ischaemic or haemorrhagic stroke
Prior major bleeding or predispositionAnaemia, bleeding diathesis, iron deficiency
Labile INRUnstable/high INR; < 60% time in therapeutic range (if on warfarin)
Elderly (> 65 years)Age alone is a modifiable target — fall risk assessment
Drugs increasing bleeding riskAntiplatelets, NSAIDs, concurrent anticoagulants
Alcohol use ≥ 8 drinks/weekModifiable risk factor
HAS-BLED Score
0
Low Bleeding Risk
~1.1% major bleeding/year
Anticoagulation safe to initiate. Annual review recommended.
/ 9 points

Major Bleeding / Year

0 — Low1.1%
1 — Low1.0%
2 — Moderate1.9%
3 — High3.7%
≥ 4 — High8.7–12.5%

⚠️ Key Reminder

HAS-BLED identifies correctable risk factors. Score ≥ 3 means increase monitoring, not stop anticoagulation. Net benefit of anticoagulation still favours treatment in most AF patients with CHA₂DS₂-VASc ≥ 2.

Wells Score — Pulmonary Embolism
Pre-test probability for PE. Use with D-dimer to determine need for CT-PA. New RBBB, right heart strain, S1Q3T3 on ECG raises suspicion.
Clinical signs and symptoms of DVTLeg swelling, erythema, tenderness of deep veins
PE is #1 diagnosis OR equally likelyNo alternative diagnosis explains the presentation better
Heart rate > 100 bpmOn presentation
Immobilisation ≥ 3 days OR surgery within 4 weeksBedrest, long-haul travel, post-operative
Previous DVT or PEObjectively diagnosed prior history
HaemoptysisCoughing up blood — suggests pulmonary infarction
MalignancyOn treatment, treated within 6 months, or palliative
Wells Score (PE)
0
Low Probability
~2% PE prevalence
D-dimer if PERC not met. Normal D-dimer rules out PE without imaging.
Max 12.5 pts

Pre-test Probability

≤ 1 Low~2%
2–6 Moderate~28%
> 6 High~73%

ECG Clues for PE

S1Q3T3 (most specific, uncommon) · Sinus tachycardia (most common) · New RBBB · T-wave inversion V1–V4 · Right axis deviation · AF

PESI / sPESI — Pulmonary Embolism Severity
Guides disposition after confirmed PE diagnosis. sPESI 0 = low risk (outpatient candidate).
Age > 80 years
CancerActive or treated within 6 months
Chronic cardiopulmonary diseaseHeart failure or chronic lung disease
Heart rate ≥ 110 bpm
Systolic BP < 100 mmHg
SpO₂ < 90%
sPESI Score
0
Low Risk
sPESI 0 — ~1.0% 30-day mortality
Consider outpatient treatment
sPESI 0 = low risk. Consider outpatient DOAC (rivaroxaban or apixaban) if no other contraindications. Close follow-up within 5 days.
sPESI / 6 points

sPESI Outcomes

0 — Low risk~1.0%
≥ 1 — High risk~10.9%

Full PESI Classes

I ≤ 65~1.1–1.6%
II 66–85~1.7–3.5%
III 86–105~3.2–7.1%
IV 106–125~4.0–11.4%
V > 125~10–24.5%
QTc Calculator
Corrected QT interval using three validated formulas. Bazett is most commonly used clinically. QTc ≥ 500 ms = high TdP risk.
QT interval (ms)Measured from QRS onset to end of T wave
Heart rate (bpm)
SexAffects normal thresholds
Primary (Bazett)
—
Enter QT + HR
All three formulas will appear below
Enter QT interval and heart rate.

All Formulas

Bazett (QT/√RR) —
Fridericia (QT/∛RR) —
Framingham —

Risk Thresholds

Men < 440 msNormal
Women < 450 msNormal
440–500 msBorderline
≥ 500 msHigh TdP risk
LVH Voltage Criteria
Checks Sokolow-Lyon, Cornell voltage, Cornell product, and R-wave criteria. Voltage criteria have ~40–50% sensitivity, ~85–90% specificity.
SexAffects Cornell voltage threshold
Precordial Leads
S wave in V1 (mm)
R wave in V5 (mm)
R wave in V6 (mm)
S wave in V3 (mm)Required for Cornell voltage
Limb Leads
R wave in aVL (mm)
R wave in I (mm)
S wave in III (mm)For R I + S III criterion
QRS duration (ms)For Cornell product — leave blank if unknown
Criteria Met
0
No LVH Criteria Met
Enter lead values to check criteria
Enter voltage measurements to check LVH criteria.
/ 5 criteria

Individual Criteria

Sokolow-Lyon
S(V1)+R(V5/V6) >35mm —
Cornell Voltage
R(aVL)+S(V3) —
Cornell Product
>2440 mm·ms —
R(aVL) alone
>11mm —
R(I) + S(III)
>25mm —
Sgarbossa Criteria
MI diagnosis in LBBB or ventricular-paced rhythm. Original score ≥ 3 = positive. Modified uses ST/S ratio. Sgarbossa 1996 · Smith 2012.
Original Sgarbossa (Score ≥ 3 = Positive)
Concordant STE ≥ 1 mm in any leadST elevation in SAME direction as QRS deflection — most specific
Concordant STD ≥ 1 mm in V1–V3ST depression where QRS is predominantly negative
Excessively discordant STE ≥ 5 mmST elevation opposite to QRS, but ≥ 5 mm absolute — less specific
Modified Sgarbossa — Replaces Criterion 3 (Smith 2012)
ST elevation in worst discordant lead (mm)Absolute ST elevation in lead where QRS is negative
S wave depth in same lead (mm)Absolute S wave amplitude — ST/S ratio > 0.25 = positive
Sgarbossa Score
0
Negative
Score 0 — criteria not met
Negative Sgarbossa does NOT exclude MI — sensitivity only 36%. Treat on clinical grounds. Serial ECGs + troponins.
/ 10 points

Original Criteria

Concordant STE ≥ 1 mm+5
Concordant STD V1–V3+3
Discordant STE ≥ 5 mm+2
Positive threshold≥ 3 pts

Modified (Smith)

Sensitivity80%
Specificity99%
ST/S ratio> 0.25
NYHA Functional Classification
New York Heart Association functional classification of heart failure. Symptom-based staging used to guide therapy, ICD/CRT criteria, and prognosis.
Select functional class based on symptoms
Class Descriptions
Class ICardiac disease; no limitation of ordinary physical activity. Ordinary activity does not cause symptoms.
Class IISlight limitation. Comfortable at rest. Ordinary activity (climbing stairs, walking on level ground) causes fatigue, palpitations, or dyspnoea.
Class IIIMarked limitation. Comfortable only at rest. Less than ordinary activity causes symptoms.
Class IVInability to carry out any activity without discomfort. Symptoms present at rest. Any activity increases discomfort.
NYHA Class
Class I
No Limitation
No symptoms during ordinary activity
5-year mortality ~15–20%
GDMT as per underlying condition. BP and lipid optimisation. Annual review.

5-Year Mortality

Class I~15–20%
Class II~25–30%
Class III~50%
Class IV~50–75%
AHA / ACC Heart Failure Staging
2022 AHA/ACC/HFSA Guideline — Stage A through D, emphasising prevention. Select the stage that best describes the patient.
Select HF Stage
Stage Descriptions
Stage A — At RiskRisk factors present (HTN, DM, obesity, family history, CAD, cardiotoxin exposure). No structural disease, no symptoms.
Stage B — Pre-HFStructural or functional abnormality detected (LVH, low EF, prior MI, valve disease) without current or past HF symptoms.
Stage C — Heart FailureStructural heart disease with current or prior symptoms of HF. This includes the majority of patients presenting to clinic.
Stage D — Advanced HFSevere symptoms at rest or with minimal exertion despite optimised GDMT. Recurrent hospitalisations, poor quality of life.
HF Stage
Stage A
At Risk for HF
No structural disease; risk factors present
Control HTN, DM, lipids, obesity. Exercise. Avoid cardiotoxins. Genetic testing for familial cardiomyopathies.

Guideline Targets

A — Prevent onsetRisk mod.
B — Prevent symptomsACE-I/ARB
C — GDMT4 pillars
D — Advanced RxLVAD/Txp
HF Classification by Ejection Fraction
ESC 2021 · AHA/ACC/HFSA 2022 — EF-based subtype classification. Guides specific pharmacotherapy and device decisions.
Left ventricular ejection fraction (%)Enter EF from echocardiography, MUGA, or cardiac MRI
HF Subtype
—
Enter LVEF
Enter ejection fraction to classify
Enter LVEF to see classification and evidence-based management.

EF Thresholds

HFrEF≤ 40%
HFmrEF41–49%
HFpEF≥ 50%
CKD Staging — KDIGO 2012
eGFR + albuminuria combined staging. Risk category guides monitoring frequency, referral, and renal dose-adjustments for cardiac medications.
eGFR (ml/min/1.73 m²)CKD-EPI or MDRD equation
Albuminuria categoryUrine albumin-to-creatinine ratio
eGFR Stages
G1 ≥ 90 / G2 60–89Normal to mildly decreased — CKD only if kidney damage markers present
G3a 45–59 / G3b 30–44Mild to moderate–severe decrease; dose-adjust renally-cleared drugs
G4 15–29Severely decreased — prepare for renal replacement therapy; refer to nephrology
G5 < 15Kidney failure — dialysis or transplant; avoid metformin, NSAIDs, IV contrast without precautions
CKD Stage
—
Enter eGFR
Enter eGFR and select albuminuria category
Enter eGFR to see CKD stage and risk category.

KDIGO Risk Heatmap

G1–G2 + A1Low
G1–G2 + A2 / G3a+A1Moderate
G3a–A2 / G3b+A1High
G3b–G5 + A2/A3Very High
AFib Type Classification
ESC 2020 · AHA/ACC/HRS 2023 — duration and rhythm-control status based classification. Stroke risk is the same across all types.
Select AFib type
Type Definitions
First DetectedSingle newly diagnosed episode regardless of duration or prior undetected episodes.
ParoxysmalSelf-terminates within 7 days (usually < 48h). Recurrent episodes.
PersistentSustained > 7 days, or requires cardioversion to terminate.
Long-standing PersistentContinuous AFib > 12 months with rhythm control still being attempted.
PermanentAFib accepted by patient and physician; rhythm control no longer pursued.
AFib Type
First Detected
First Detected Episode
Stroke risk same across all AFib types
Anticoagulate per CHA₂DS₂-VASc. Evaluate for precipitants: thyroid, sepsis, alcohol, PE, MI. Echo for structural disease.

Key Principle

Stroke risk is the same across paroxysmal, persistent, and permanent AFib. Anticoagulation decision is based on CHA₂DS₂-VASc, not AFib type.

Killip Classification
Clinical heart failure severity at time of MI. Predicts in-hospital mortality. Killip & Kimball, Am J Cardiol 1967.
Select Killip Class at admission
Class Definitions
Class INo clinical signs of cardiac decompensation. No S3, no rales.
Class IIMild–moderate heart failure. S3 gallop, rales in ≤ 50% of lung fields, elevated JVP.
Class IIISevere HF / pulmonary oedema. Rales in > 50% of lung fields, marked respiratory distress.
Class IVCardiogenic shock. SBP < 90 mmHg despite volume, peripheral vasoconstriction, oliguria, cyanosis.
Killip Class
Class I
No Heart Failure
No signs of cardiac decompensation
In-hospital mortality ~6%
Standard STEMI / ACS care. DAPT, anticoagulation, beta-blocker, ACE-I. Early reperfusion.

In-Hospital Mortality

Class I~6%
Class II~17%
Class III~38%
Class IV~61–81%
TIMI Score — STEMI
Predicts 30-day all-cause mortality in STEMI. Score 0–14. Morrow et al., Circulation 2000.
AgeAge at presentation
Diabetes, hypertension, or anginaAny of these pre-existing conditions
Systolic BP < 100 mmHgOn presentation — haemodynamic compromise
Heart rate > 100 bpmOn presentation
Killip Class II–IVAny signs of HF: rales, S3, pulmonary oedema, or cardiogenic shock
Weight < 67 kg
Anterior STE or new / presumed new LBBBAnterior or extensive territory
Time to treatment > 4 hoursFrom symptom onset to reperfusion
TIMI STEMI Score
0
Low Risk
~0.8% 30-day mortality
Standard primary PCI. Timely reperfusion is the priority. DAPT + anticoagulation per ACS protocol.
/ 14 points

30-Day Mortality

0–3 Low0.8–4.4%
4–6 Moderate7.3–16%
≥ 7 High23–36%
CRUSADE Bleeding Score
Estimates in-hospital major bleeding risk after NSTEMI. Score 1–96. Subherwal et al., Circulation 2009.
Baseline Haematocrit (%)Admission haematocrit
Creatinine Clearance (ml/min)Cockcroft–Gault; use 15 if on dialysis
Heart Rate (bpm)On admission
Systolic BP (mmHg)On admission
Female sex
Signs of congestive heart failureAt time of presentation
Prior vascular diseaseKnown CAD, PVD, or prior stroke
Diabetes mellitus
CRUSADE Score
—
Enter values
Fill in numeric fields to calculate.
Complete all fields for bleeding risk stratification.
Max 96 pts

Major In-Hospital Bleeding

≤ 20 Very Low~3.1%
21–30 Low~5.5%
31–40 Moderate~8.6%
41–50 High~11.9%
> 50 Very High~19.5%