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Recent fainting episode Sudden death History of SADS in family Recent diagnosis of heart rhythm disorder Have Family/Friend diagnosed Network with other families Interested in Genetic Testing Volunteer with SADS Fundraise with SADS More Information on LQT Learn about medication to avoid with LQT Other:
My doctor Family/Friend WWW TV Newspaper Radio Other
Symptoms: (choose multiple) syncope (fainting) seizure palpitations cardiac arrest Other:
Medical Condition: (choose only 1 here) Long QT Syndrome CPVT Brugada HCM ARVD Other
Current Treatment: (choose multiple) Betablocker Other medication ICD Pacemaker Other:
Cause of Death: (choose only 1 here) Long QT Syndrome CPVT Brugada Syndrome HCM ARVD Unknown Other
Symptoms before death: (choose multiple) Diagnosed before death: Yes No syncope (fainting) seizure palpitations cardiac arrest None Other:
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