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PPE Cardiac Risk (AHA 14-Element) Calculator

  • Exertional chest pain/discomfort
  • Unexplained syncope/near-syncope
  • Excessive exertional dyspnea/fatigue or palpitations with exercise
  • Prior recognition of a heart murmur (history)
  • Elevated systemic blood pressure (history)
  • Prior restriction from sports participation
  • Prior cardiac testing ordered by a physician
  • Family history: premature death (<50 y) due to heart disease
  • Family history: disability from heart disease in a close relative <50 y
  • Family history: known cardiomyopathy/channelopathy/Marfan/clinically significant arrhythmias
  • Physical exam: pathologic heart murmur
  • Physical exam: diminished femoral pulses (suspect coarctation)
  • Physical exam: stigmata of Marfan syndrome
  • Seated brachial blood pressure (mmHg)
  • Preparticipation Physical Evaluation (PPE) Cardiac Screening: Explanation and Clinical Context
    This calculator implements the American Heart Association (AHA) 14-element cardiovascular screening checklist used during the PPE to identify athletes at risk for congenital or genetic heart disease associated with sudden cardiac arrest or death.
    It aggregates the 10 history items and 4 focused examination items, providing a total positive count and highlighting “high-concern” findings such as exertional chest pain, unexplained syncope, or family history of premature sudden cardiac death.

    Clinical Interpretation:
    A “Screen Negative” result (no positive items, normal blood pressure) supports clearance without cardiac restriction. Any high-risk item or elevated blood pressure should prompt further cardiac evaluation. The AHA 14-element checklist is designed for screening, not for quantitative risk prediction. ECG and echocardiography may be added based on resource availability.

    References:
    Maron BJ, et al. Recommendations and Considerations Related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes. Circulation. 2007;115:1643–1655.
    Maron BJ, et al. American Heart Association 14-Element Screening Checklist. Circulation. 2014 Update.
    Williams EA, et al. Performance of the AHA 14-Point Evaluation Compared with ECG in High School Athletes. J Am Heart Assoc. 2019;8:e012235.
    American Academy of Pediatrics, AAFP, ACSM. Preparticipation Physical Evaluation Monograph, 5th ed. 2023.

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