AFibbers Database: Add new record

	AFibbers Database: Add new record

Your name (for public display - anon is OK)

Location (eg London, UK)

Age

Email (not for public display)

Password (to allow you to edit your entry)

Confirm Password (to allow you to edit your entry)*

Diagnosed condition

How many years with condition

Frequency of episodes

Duration of episodes

Illness / major event preceding first AF

General Health (asthmatic, smoker, drinker...)

Current state (cured, very ill...)

Known triggers

Known preventions

Current medications/side effects

Previous medications/side effects

History of surgery

Future plans

Personal comments

Please check all which apply

acebutolol	amiodarone (cordarone,pacerone)	anisindione (miradon)
atenolol (tenormin)	aspirin	azimilide
bepridil	betaxolol	bisoprolol (monocor,emconcor)
bretylium	bucindolol	carvedilol
cibenzoline	dicumarol	digitoxin
digoxin (lanoxin)	diltiazem (cardizem)	diphenylhydantoin
disopyramide (norpace)	dofetilide (tikosyn)	dronedarone
encainide	esmolol (brevibloc)	ersentilide
flecainide (tambocor)	gallopamil	ibutilide (corvert)
lidocaine	mibefradil	metoprolol (lopressor,toprol xl)
mexiletine	moricizine	nadolol
phenytoin	procainamide	propafanone (rythmol)
propranolol (inderal)	quinapril (accupril)	quinidine (quinaglute)
sotalol (betapace)	tedisamil	timolol
tocainide	trandolapril (mavik)	valsartan (diovan)
verapamil (calan,isoptin)	warfarin (coumadin)	asthma
diabetes	GERD/acid reflux	hypertension
hypotension	hyperthyroidism	hypothyroidism
adrenergic	vagal	familial
idiopathic/lone	paroxysmal	permanent/chronic
atrial flutter	cardiomyopathy	CHF
PAC	PVC	SVT
syncope	bradycardia	tachycardia
heart block	myocardial infarction	rheumatic heart diease
sick sinus syndrome	stroke	WPW
electrical cardioversion	defibrillator	pacemaker
ablation	bypass	maze
Male	Female

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