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AFibbers Database: Add new record

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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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