Sudden Cardiac Arrest

Sudden Cardiac Arrest (SCA) is a condition in which the heart unexpectedly stops functioning. When this happens, blood stops flowing to the brain and other vital organs, causing loss of consciousness or seizure-like activity in seconds. If not treated immediately, SCA results in death. The normal rhythm of the heart can only be restored with defibrillation, an electrical shock that is safely delivered to the chest by an automated external defibrillator (AED).

Act 73 (Peyton's Law)

The Sudden Cardiac Arrest Prevention Act (Act 59 of 2012) was adopted by the Commonwealth of Pennsylvania on May 29, 2012.  Act 59, in part, required: student athletes, and parents of student athletes, to read and sign an acknowledgement form regarding SCA; coaches to complete an annual training course; and student athletes to stop participating in athletic activity if they were showing signs or symptoms of SCA until they could be evaluated and cleared by a licensed physician, certified registered nurse practitioner or cardiologist. 

On July 23, 2020, Act 59 was repealed, and Act 73 was adopted to take its place.  Act 73 includes the same requirements of Act 59 but added requirements for electrocardiogram information and testing to be provided to parents of student athletes and student athletes.  Coaches must still complete an annual training course on sudden cardiac arrest. 

Background Information on SCA

Although SCA happens unexpectedly, some people may have warning signs or symptoms, such as:

• Dizziness or lightheadedness during exercise;
• Fainting/passing out during or after exercise;
• Shortness of breath or difficulty breathing with exercise, not asthma related;
• Racing, skipped beats or fluttering heartbeat (palpitations);
• Fatigue (extreme or recent onset of tiredness);
• Weakness; and/or
• Chest pains/pressure or tightness during or after exercise.

These symptoms can be unclear and confusing to athletes; some athletes ignore the signs or think they are normal or from physical exhaustion.  If the conditions that cause SCA are diagnosed and treated before a life-threatening event, sudden cardiac death can be prevented in many young athletes. 

There are risks associated with continuing to practice or play after experiencing these symptoms.  The symptoms might mean something is wrong with the athlete, and they should be checked before returning to play.  When the heart stops due to a cardiac arrest, so does the blood that flows to the brain and other vital organs.  Death or permanent brain damage can occur in just a few minutes. Most people who experience a SCA die from it; survival rates are below 10 percent.

Act 73: Removal from Play / Return to Play

Any student-athlete who has warning signs or symptoms of SCA must be removed from play or practice. The symptoms can happen before, during or after activity. Play includes all athletic activity.

Before returning to play, the athlete must be evaluated. Clearance to return to play must be in writing. The evaluation must be performed by a licensed physician, certified registered nurse practitioner, or cardiologist. The medical provider may consult any other licensed or certified medical professional.

Electrocardiogram (ECG/EKG)

An ECG/EKG is a quick, painless and noninvasive test that measures and records a moment in time of the heart's electrical activity.  Small electrode patches are attached to the skin of your chest, arms and legs by a technician.  An ECG/EKG provides information about the structure, function, rate and rhythm of the heart.

Adding an ECG/EKG to the history and physical exam can suggest further testing or help identify up to two-thirds of heart conditions that can lead to SCA.

• An ECG/EKG can be ordered by your physician for screening for cardiovascular disease (ICD 10 code: Z13.6) or for a variety of symptoms such as chest pain, palpitations, dizziness, fainting, or family history of heart disease and will generally be paid for by insurance.
• ECG/EKG screenings should be considered every 1-2 years because young hearts grow and change.
• ECG/EKG screenings may increase sensitivity for detection of undiagnosed cardiac disease but may not prevent SCA.
• ECG/EKG screenings with abnormal findings will need to be evaluated by trained physicians. 
• If the ECG/EKG screening has abnormal findings, additional testing may need to be done (with associated cost and risk) before a diagnosis can be made, and may prevent the student from participating in sports for a short period of time until the testing is completed and more specific recommendations can be made.
• The ECG/EKG can have false positive findings, suggesting an abnormality that does not really exist after more testing (false positive findings occur less than 3% of the time when ECG/EKGs are read by a medical practitioner proficient in ECG/EKG interpretation of children, adolescents and young athletes.). 
• ECGs/EKGs result in fewer false positives than the current history and physical exam (10%).
• The American College of Cardiology/American Heart Association guidelines do not recommend an ECG or EKG in asymptomatic patients but do support local programs in which ECG or EKG can be applied with high-quality resources.

Additional Resources for Sudden Cardiac Arrest

• Athlete/Parent/Guardian Sudden Cardiac Arrest Information and Receipt/ Review Acknowledgement
• Parent Heart Watch 
• Sudden Arrythmia Death Syndromes Foundation 
• Simon's Heart Fact Sheet (for students)
• National Heart, Lung and Blood Institute (NHLBI) Information about Sudden Cardiac Arrest
  
• COACHES: You Could Save a Life! 
  Information and risk assessment form.
  
• Pediatric Sudden Cardiac Arrest
  Policy Statement on Pediatric Sudden Cardiac Arrest from the American Academy of Pediatrics.
• Sudden Cardiac Arrest Fact Sheet