# Marburg Heart Score MHS Status: LIVE Price: $0.005 USDC `GET /api/calc/mhs` HTML: https://magentlab.com/docs/mhs Markdown: https://magentlab.com/docs/mhs.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the five Bösner 2010 Marburg Heart Score determinants and return the published positive (3–5) or negative (≤2) cut-off. ## When to use When an agent needs the published primary-care MHS total and must not invent the four findings or treat the score as an ED ACS rule-out. ## When not to use - Not a medical device. - Primary-care chest-pain rule only (Bösner 2010). Not an ACS rule-out in the emergency department. - Not a diagnosis or admission order. - The caller assigns the four clinical flags. magent does not interview the patient. ## Formula ``` MHS = age_sex (female ≥65 or male ≥55) + known_vascular_disease + assumes_cardiac_origin + pain_worse_exercise + pain_not_reproducible; each 1; max 5; positive 3–5, negative ≤2 (Bösner 2010 Table 3) ``` ## Citation [Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule](https://doi.org/10.1503/cmaj.100212) Bösner S, Haasenritter J, Becker A, Karatolios K, Vaucher P, Gencer B, Herzig L, Heinzel-Gutenbrunner M, Schaefer JR, Abu Hani M, Keller H, Sönnichsen AC, Baum E, Donner-Banzhoff N CMAJ. 2010;182(12):1295-1300 DOI: [10.1503/cmaj.100212](https://doi.org/10.1503/cmaj.100212) ## Worked example ### Age 40 female, all flags false Given: `age=40, assumes_cardiac_origin=false, known_vascular_disease=false, pain_not_reproducible=false, pain_worse_exercise=false, sex=female` 1. Female 40 is not ≥65 → 0; four flags false → 0 each 2. Score = 0 (max 5); mhs_result negative (≤2) ### Three flags present (published positive cut-off) Given: `age=40, assumes_cardiac_origin=true, known_vascular_disease=true, pain_not_reproducible=false, pain_worse_exercise=true, sex=female` 1. Female 40 → 0; three flags true → 3 2. Score = 3 (max 5); mhs_result positive (3–5) ## Also searched as - Marburg Heart Score - MHS score - Bösner prediction rule - primary care CAD rule - chest pain primary care score - Marburg score coronary - Bösner 2010 chest pain ## Parameters - `age` (integer, required): Age in years (18-120). Combined with sex: female ≥65 or male ≥55 scores 1 (Bösner 2010 Table 3). magent computes this; do not send a precomputed flag. - `sex` (string, required): female or male. Combined with age: female ≥65 or male ≥55 scores 1 (Bösner 2010 Table 3). - `known_vascular_disease` (boolean, required): Known clinical vascular disease: coronary, cerebrovascular, or peripheral (Bösner 2010). true or false as assigned by the caller. - `assumes_cardiac_origin` (boolean, required): Patient assumes the pain is of cardiac origin (Bösner 2010). true or false as assigned by the caller. magent does not interview the patient. - `pain_worse_exercise` (boolean, required): Pain worse with exercise (Bösner 2010). true or false as assigned by the caller. - `pain_not_reproducible` (boolean, required): Pain is not reproducible by palpation (Bösner 2010). true when that published finding is present; false if pain is reproducible. Assigned by the caller. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/mhs` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "age": "40", "assumes_cardiac_origin": "false", "known_vascular_disease": "false", "pain_not_reproducible": "false", "pain_worse_exercise": "false", "sex": "female" }, { "age": "40", "assumes_cardiac_origin": "false", "known_vascular_disease": "false", "pain_not_reproducible": "false", "pain_worse_exercise": "false", "sex": "female" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/mhs Example 200: ```json { "count": 2, "path": "/api/calc/mhs", "items": [ { "components": [ { "value": 40, "factor": "age_sex", "points": 0, "present": false }, { "factor": "known_vascular_disease", "points": 0, "present": false }, { "factor": "assumes_cardiac_origin", "points": 0, "present": false }, { "factor": "pain_worse_exercise", "points": 0, "present": false }, { "factor": "pain_not_reproducible", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Bösner S, Haasenritter J, Becker A, Karatolios K, Vaucher P, Gencer B, Herzig L, Heinzel-Gutenbrunner M, Schaefer JR, Abu Hani M, Keller H, Sönnichsen AC, Baum E, Donner-Banzhoff N", "doi": "10.1503/cmaj.100212", "id": "bosner-2010", "pmid": "20603345", "source": "CMAJ. 2010;182(12):1295-1300", "title": "Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule" }, "formula": "mhs", "formula_expression": "MHS = age_sex (female ≥65 or male ≥55) + known_vascular_disease + assumes_cardiac_origin + pain_worse_exercise + pain_not_reproducible; each 1; max 5; positive 3–5, negative ≤2 (Bösner 2010 Table 3)", "age_years": 40, "max_score": 5, "score": 0, "sex": "female", "mhs_result": "negative" }, { "components": [ { "value": 40, "factor": "age_sex", "points": 0, "present": false }, { "factor": "known_vascular_disease", "points": 0, "present": false }, { "factor": "assumes_cardiac_origin", "points": 0, "present": false }, { "factor": "pain_worse_exercise", "points": 0, "present": false }, { "factor": "pain_not_reproducible", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Bösner S, Haasenritter J, Becker A, Karatolios K, Vaucher P, Gencer B, Herzig L, Heinzel-Gutenbrunner M, Schaefer JR, Abu Hani M, Keller H, Sönnichsen AC, Baum E, Donner-Banzhoff N", "doi": "10.1503/cmaj.100212", "id": "bosner-2010", "pmid": "20603345", "source": "CMAJ. 2010;182(12):1295-1300", "title": "Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule" }, "formula": "mhs", "formula_expression": "MHS = age_sex (female ≥65 or male ≥55) + known_vascular_disease + assumes_cardiac_origin + pain_worse_exercise + pain_not_reproducible; each 1; max 5; positive 3–5, negative ≤2 (Bösner 2010 Table 3)", "age_years": 40, "max_score": 5, "score": 0, "sex": "female", "mhs_result": "negative" } ] } ``` ## Response fields - `formula` (string): mhs - `formula_expression` (string): Exact expression used - `score` (integer): MHS points 0-5 - `max_score` (integer): 5 - `mhs_result` (string): Published Bösner 2010 discrimination cut-off: positive (3-5) or negative (≤2). Not a diagnosis or admission order. - `sex` (string): female or male used with age for the age/sex determinant - `age_years` (integer): Age used with sex for the age/sex determinant - `components` (array): Per-determinant points - `citation` (object): Bösner et al. CMAJ 2010 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 40, "factor": "age_sex", "points": 0, "present": false }, { "factor": "known_vascular_disease", "points": 0, "present": false }, { "factor": "assumes_cardiac_origin", "points": 0, "present": false }, { "factor": "pain_worse_exercise", "points": 0, "present": false }, { "factor": "pain_not_reproducible", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Bösner S, Haasenritter J, Becker A, Karatolios K, Vaucher P, Gencer B, Herzig L, Heinzel-Gutenbrunner M, Schaefer JR, Abu Hani M, Keller H, Sönnichsen AC, Baum E, Donner-Banzhoff N", "doi": "10.1503/cmaj.100212", "id": "bosner-2010", "pmid": "20603345", "source": "CMAJ. 2010;182(12):1295-1300", "title": "Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule" }, "formula": "mhs", "formula_expression": "MHS = age_sex (female ≥65 or male ≥55) + known_vascular_disease + assumes_cardiac_origin + pain_worse_exercise + pain_not_reproducible; each 1; max 5; positive 3–5, negative ≤2 (Bösner 2010 Table 3)", "age_years": 40, "max_score": 5, "score": 0, "sex": "female", "mhs_result": "negative" } ``` ## Errors - HTTP 400 `invalid_age`: age must be an integer from 18 to 120 Returned before settlement; you are not charged. - HTTP 400 `invalid_sex`: sex must be female or male Returned before settlement; you are not charged. - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [HEART score](https://magentlab.com/docs/heart) — Compute the HEART score as age points plus caller-assigned history, ECG, risk factors, and troponin (each 0-2). - [EDACS](https://magentlab.com/docs/edacs) — Compute the Than 2014 Emergency Department Assessment of Chest pain Score from age, sex, and caller-assigned flags. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.