Sudden cardiac arrest (SCA) is the abrupt and unexpected loss of heart function. SCA can be fatal if not treated within minutes, and even with treatment death may occur. Immediate treatment is cardiopulmonary resuscitation (CPR) and use of an automatic external defibrillator (AED).

Although SCA is rare in children and youth — the incidence of sudden cardiac death (SCD) among persons aged one through 18 years ranged from less than 1 to 4 deaths per 100,000 population per year¹ — there are steps parents and guardians and school personnel can take to identify students who may be at risk and help to identify students exhibiting signs or symptoms. These signs or symptoms may be misinterpreted or disregarded by the student or others, but are an important indication that a student should be seen by a healthcare provider for an evaluation. Additionally, a student may have personal risk factors or family history risk factors that indicate they are potentially at increased risk for SCA and should be evaluated by a healthcare provider prior to participating in athletics.

The signs and symptoms and risk factors listed below, developed in collaboration with the New York State Department of Health (NYSDOH) and pediatric cardiologists, indicate when a student may be at risk for SCA.²

Signs and Symptoms

• Fainting or seizure, especially during or right after exercise or with excitement or startle
• Racing heart, palpitations or irregular heartbeat
• Dizziness, lightheadedness or extreme fatigue with exercise
• Chest pain or discomfort with exercise
• Excessive shortness of breath during exercise
• Excessive, unexpected fatigue during or after exercise

Risk Factors

Personal Risk Factors

• Use of diet pills, performance-enhancing supplements, energy drinks or drugs such as cocaine, inhalants or “recreational” drugs³
• Elevated blood pressure or cholesterol
• History of health care provider ordered test(s) for heart-related issues

Family History Risk Factors

• Family history of known heart abnormalities or sudden death before 50 years of age
• Family members with unexplained fainting, seizures, drowning, near drowning or car accidents before 50 years of age
• Structural heart abnormality, repaired or unrepaired
• Any relative diagnosed with the following conditions:
  • Enlarged heart/hypertrophic cardiomyopathy/dilated cardiomyopathy
  • Arrhythmogenic right ventricular cardiomyopathy
  • Heart rhythm problems, long or short QT interval
  • Brugada syndrome
  • Catecholaminergic ventricular tachycardia
  • Marfan syndrome — aortic rupture
  • Heart attack at 50 years or younger
  • Pacemaker or implanted cardiac defibrillator (ICD)

Any student with such signs or symptoms, family history or personal risk factors should be evaluated by a healthcare provider before participating in athletics. This is important since SCA can be triggered by athletic activities in students at risk.³

Any student displaying signs or symptoms of pending SCA must be immediately removed from athletic activities and not resume athletic activities until they have been evaluated by and received written signed authorization to do so from a licensed physician.

¹Ackerman, M., Atkins, DL., Triedman, JK. Sudden cardiac death in the young, Circulation. 2016;133, (10): 1006-1026.

²SECTION ON CARDIOLOGY AND CARDIAC SURGERY, Robert Campell, Stuart Berger, Michael J. Ackerman, W. Robert Morrow, Kathy Jenkins, L. LuAnn Minich, Geoffrey L. Rosenthal, Christopher S. Snyder, James Twedell; Pediatric Sudden Cardiac Arrest. Pediatrics April 2012; 129 (4): e1094–e1102. 10.1542/peds.2012-0144.

³SCA Prevention Toolkit — Eric Paredes Save A Life Foundation (epsavealife.org)

Dominic Murray Sudden Cardiac Arrest Prevention Act

The Dominic Murray Sudden Cardiac Arrest Prevention Act, signed into law by New York State Governor Kathy Hochul on Oct. 25, 2021 and effective July 1, 2022, ensures that schools, students and parents are provided with critical, lifesaving information on sudden cardiac arrest (SCA) risks, signs and symptoms, to ensure students at risk are evaluated prior to participation in athletics, and that SCA is immediately recognized and treated to prevent death. The act requires:

• The Commissioner of Health to develop information, in conjunction with the Commissioner of Education, relating to pupils exhibiting signs or symptoms of pending or increased risk of sudden cardiac arrest
• Directs the Commissioner of Education to post the information on the New York State Education (NYSED) Department’s website
• All schools must include such information in any permission form, consent form, or similar document that may be required for a student’s participation in interscholastic athletics or reference how to obtain such information from the Department and Department of Health’s websites or on the school’s website
• The Commissioner of Education to promulgate regulations requiring that any student displaying signs or symptoms of pending or increased risk of sudden cardiac arrest shall be immediately removed from athletic activities, and shall not resume athletic activity until he or she has been evaluated by and received written and signed authorization from a licensed physician; and retain the authorization on file in the student’s permanent health record

NYSED memo to school superintendents and administrators regarding Dominic Murray SCA Act

Superintendent's letter to families regarding Dominic Murray SCA Act