Important Considerations in the Evaluation of Patients With Known or Suspected VA Component Assessment and Findings Relevant for VA and/or SCD Risk History 1. Symptoms/events related to arrhythmia: Palpitations, lightheadedness, syncope, dyspnea, chest pain, cardiac arrest Symptoms related to underlying heart disease: Dyspnea at rest or on exertion, orthopnea, paroxysmal nocturnal dyspnea, chest pain, edema 3. Precipitating factors: Exercise, emotional stress Known heart disease: Coronary, valvular (eg, mitral valve prolapse), congenital heart disease, other Risk factors for heart disease: Hypertension, diabetes mellitus, hyperlipidemia, and smoking Antiarrhythmic medications Other medications with potential for QT prolongation and torsades de pointes Medications with potential to provoke or aggravate VA Stimulants including cocaine and amphetamines Supplements including anabolic steroids Medication-medication interaction that could cause QT prolongation and torsades de pointes 7. Past medical history Thyroid disease Acute kidney injury, chronic kidney disease, or electrolyte abnormalities Stroke or embolic events Lung disease Epilepsy (arrhythmic syncope can be misdiagnosed as epilepsy) Alcohol or illicit drug use Use of over-the-counter medications that could cause QT prolongation and torsades de pointes Unexplained motor vehicle crashes Family History 1. SCD, SCA, or unexplained drowning in a first-degree relative SIDS or repetitive spontaneous pregnancy losses given their potential association with cardiac channelopathies 3. Heart disease IHD Cardiomyopathy: Hypertrophic, dilated, ARVC Congenital heart disease Cardiac channelopathies: Long QT, Brugada, Short QT, CPVT Arrhythmias Conduction disorders, pacemakers/ICDs Neuromuscular disease associated with cardiomyopathies Muscular dystrophy (Continued) Examination 1. Heart rate and regularity, blood pressure 2. Jugular venous pressure 4. Pulses and bruits 6. Sternotomy scars ARVC indicates arrhythmogenic right ventricular cardiomyopathy; CPVT, catecholaminergic polymorphic ventricular tachycardia; IHD, ischemic heart disease; SCA, sudden cardiac arrest; SCD, sudden cardiac death; SIDS, sudden infant death syndrome; and VA, ventricular arrhythmia. Table 6. 