During the swimsuit competition, Michaela Gagne also will display a scar on her upper chest. It's a distinctive mark Gagne views with pride because she says it embodies her accomplishments: surviving and thriving after learning that she was at risk of sudden cardiac arrest.

The 24-year-old resident of Fall River, Mass., was diagnosed with long QT syndrome at age 17, a condition that could lead to unconsciousness or death during intense physical activity. Long QT is a disorder of the heart's electrical rhythm that can be fatal because of ventricular arrhythmias, or abnormally rapid heartbeats.

About 450,000 people die each year from sudden cardiac arrest, and more than 14,000 are children, according to Parent Heart Watch, a national advocacy group formed by parents who lost children to this electrical short-circuit in the heart.

Spreading awareness about the dangers and the need for prevention is Gagne's platform in the Miss America competition. "The possibilities of what can be done with the crown are endless. I can support parents (who have lost children to sudden cardiac arrest) or work to prevent unnecessary deaths," Gagne says. "I can't find a better issue to fight for than life."

She is also a national spokeswoman for the American Heart Association's "Go Red For Women" campaign, a drive to encourage women to take charge of their heart health.

An athlete's dreams

At the time of her diagnosis, Gagne was a three-season high school athlete. She says she had high hopes of playing NCAA Division I soccer at the University of Massachusetts. Her condition was not immediately diagnosed after she started feeling dizzy and lightheaded at soccer practices. But she was eventually referred to a cardiologist who identified her condition and said that she could no longer join in sports or strenuous physical activity.

"I was completely devastated and felt like my dreams were shattered. No sports? Sports were how I defined myself," Gagne said.

So she researched long QT syndrome and learned about the potential benefits of an implantable cardioverter defibrillator (ICD).

An ICD, about the size of a stopwatch, is surgically implanted and connected to the heart as a means of monitoring heart rhythms to prevent sudden cardiac arrest. The device sends electric shocks to the heart when its internal monitoring system detects irregular beats.

"I went to the doctor with the idea of implanting an ICD but wondered, 'Can I be safe with this? Can I really have no restrictions?' " Gagne said. When the device was subsequently implanted, she was left with a scar but none of the dreaded restrictions on her physical activity.

The ICD implanted in Gagne is the EnTrust model manufactured by Minneapolis-based Medtronic Inc. The devices range in price from $20,000 to $30,000, according to a company spokeswoman.

"For her, the scar is a sign of what she went through," says Gagne's mother, Denise. "It's a physical reminder of the good stuff."

Denise Gagne praises the maturity her daughter has displayed.

"She appreciates everything and truly feels the need to give and to do," she says. "She was the captain of all her sports teams. She could have dropped dead at any moment."

A national pulpit

In mid-January, Gagne traveled to Grapevine, Texas, and spoke to more than 100 members of Parent Heart Watch.

"Michaela is the representative of why we do what we do," says Laura Friend, one of the group's founders. "Yes, our kids are dead, but this is why we're fighting. … We know what we lost and what our kids missed."

Gagne says one couple told her about their daughter, Madison, who died at age 5. "The parents said, 'Good luck from one beauty queen to another; Madison will be with you at the pageant,' " Gagne says. "It's those types of moments that have made my experience absolutely unbelievable."

"The national voice I would have as Miss America to advocate for awareness and prevention of sudden cardiac arrest is incomparable. That crown is bigger than a megaphone," says Gagne.