Brugada syndrome
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Preparticipation Physical Evaluation History Form
nj.govdrowning, unexplained car accident, or sudden infant death syndrome)? 14. Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia? 15.
Instructions for Completing the NCHSAA Student-Athlete
www.nchsaa.org(HCM), Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy (ARVC), long QT syndrome (LQTS), short QT syndrome (SQTS), Brugada syndrome, or catecholaminergic poly-morphic ventricular tachycardia (CPVT)? 13. Has anyone in your family had a pacemaker or an implanted defibrillator before age 35? 12_Forms_215-226.indd 217 3/20/19 4:18 PM
ATHLETIC PARTICIPATION/PARENTAL CONSENT/PHYSICAL ...
sbo.nn.k12.va.ussyndrome, arrhythmogenic right ventricular cardiomyopathy (ARVC), long QT syndrome (LQTS), short QT syndrome (SQTS), Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia (CPVT)? # >> # >> # >> Has anyone in your family had a pacemaker or an implanted 19. defibrillator before age 35?
SPORTS QUALIFYING PHYSICAL EXAMINATION
www.mshsl.org12. Does anyone in your family have a genetic heart problem such as hypertrophic cardiomyopathy (HCM), Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy (ARVC), long QT syndrome (LQTS), short QT syndrome (SQTS), Brugada syndrome, or catecholaminergic polymorphic
Cardiology Abbreviations and Diagnosis
www.ped.med.utah.eduBrugada Syndrome EP-IA Clinic Cardiomegaly . CLD . Chronic Lung Disease PH Clinic CHARGE Syndrome . CM . Cardiomyopathy • Adriamycin • Chemotherapy Induced • Dilated (DCM) • Family Hx of • Hypertrophic (HCM or HOCM) …
Athletic Participation/Physical Examination Form KHSAA ...
khsaa.orgBrugada syndrome, or catecholaminergic poly-morphic ventricular tachycardia (CPVT)? 13. Has anyone in your family had a pacemaker or an implanted defibrillator before age 35? 12_Forms_215-226.indd 217 3/20/19 4:18 PM. BONE AND JOINT QUESTIONS Yes No 14. Have you ever had a stress fracture or an injury
TSSAA 21081211531
cms-files.tssaa.orgBrugada syndrome, or catecholaminergic poly- morphic ventricular tachycardia (CPVT)? Has anyone in your family had a pacemaker or an implanted defibrillator before age 35? 4. 5. 6. 8. Have you ever passed out or nearly passed out during or after exercise?