Sudden Cardiac Arrest Prevention Act

Heart Institute at UPMC Children’s Hospital of Pittsburgh of UPMC

Recommended Protocols for Pediatricians and Other Health Care Professionals

Pennsylvania state legislators passed House Act 59, Sudden Cardiac Arrest Prevention Act, in August of 2012. The intent of the law is to educate children, parents, and coaches about the symptoms that are associated with sudden cardiac death.

The law addresses medical clearance for sports participation. To this end, the specialists at the Heart Institute at UPMC Children’s Hospital of Pittsburgh have produced a suggested algorithm that pediatricians and other physicians may find useful.

As per PA State law (Act 59), a student athlete with the following symptoms must be evaluated by a licensed health care professional: syncope (fainting), dizziness, chest pain, difficulty breathing, and abnormal racing heart. While this list demonstrates what is required by law, licensed health care professionals should use their own judgment in determining whether other symptoms warrant an evaluation.

As pediatric cardiology experts, we at the Heart Institute suggest that licensed health care practitioners, including primary care physicians (PCP) and nurse practitioners, use the following algorithm to evaluate student athletes:

1. Patient with Prior Symptoms (occurred in the past and have resolved)

   1. Symptoms at rest – PCP can conduct the evaluation, consider ECG and/or elective (non-urgent) cardiology consultation as needed
   2. Symptoms with exercise – PCP to conduct evaluation and triage as you see fit:
      1. Patients with symptoms not attributed to other diagnoses (i.e., exercise induced asthma, musculoskeletal pain) can be referred to Children’s for cardiology consultation (particularly exercise induced syncope, chest pain or palpitations).

2. Patient with Acute Symptoms or symptoms during a recent sporting event (patient awaiting clearance to return to competition)

   1. All emergent/STAT situations: Call 911 if appropriate or refer patient to closest emergency room
   2. Non-STAT: Patients with symptoms not attributed to other diagnoses (i.e., asthma, musculoskeletal pain) can be referred to Children’s Hospital for ECG and/or cardiology consultation.

Cardiology evaluation and clearance will be limited to cardiac issues; all other issues (non-cardiac symptoms and diagnoses) will be referred back to PCP for evaluation/clearance.

The above algorithm is intended for educational purposes only and should be used in conjunction with your own clinical judgment. Additionally, the content of this letter is not intended as patient-specific medical advice or legal advice.

The Heart Institute at Children’s encourages pediatricians to continue to use best practices and judgment, above and beyond the above suggestions as clinically indicated. In an emergency, EMS (Emergency Medical Services) should be contacted or patient should be taken to the nearest emergency room.

If you have questions, feel free to contact us or our nurse practitioners through Children's Hospital's Cardiology nurse’s line at 412-692-5759.