RUTGERS vs. ARMYPENN ST. vs. UCONN

SUNDAY, DECEMBER 14 - NOON

212-307-7171

TICKETS ON SALE NOW!MSG Box OfficeTHEGARDEN.com

Free Heart ScreeningS10AM – 6PM • MSG ExPo CEntEr

Each year, more than 325,000 Americans die from Sudden Cardiac Arrest (SCA). It is estimated that SCA claims the life of up to 7,000 children and adolescents each year in the US. One way to prevent SCA is to get an electrocardiogram. If heart problems are detected early, there are safe and effective treatments available.

Every child screened will receive aFREE roCK mini-basketball.

• Interactive heart displays

• Educational exhibits

• Shoot hoops

• Meet professional athletes

• Free giveaways

Don’t miss out on this oppoRtunity to pRotEct youR liFE anD thE livEs oF thosE you lovE.

Maggie Dixon was the vibrant, passionate and successful coach of the Army Black Knights women’s basketball team. In 2006, she led her team to their first-ever appearance in the NCAA Tournament. Just weeks later, Maggie died suddenly due to an arrhythmia caused by a previously undiagnosed heart condition. She was only 28 years old.

Her team’s appearance in the NCAA Tournament was special for more than one reason. Dixon’s brother Jamie, head coach of the Pittsburgh Panthers, had also led his team to an NCAA berth. Maggie and Jamie are believed to be the first-ever brother-sister coaching duo in NCAA history.

The Dixon family, Madison Square Garden, and the C.A.R.E. Foundation, have teamed up to ensure that Maggie’s legacy sheds great light onto the need for heart disease prevention and awareness. Through education, advocacy and public awareness, lives can be saved.

In Maggie’s honor, please join us in our commitment to promote women’s college basketball and to help save lives.

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Consent to eleCtroCardiogram (eCg) sCreening

1. I consent to have an electrocardiogram (ECG) on my child, ________________________, age _________. I understand that this ECG is being offered as a preliminary screening test for certain heart disorders that may put my child at risk for arrhythmias and sudden cardiac arrest and I have requested this screening for my child.

2. I have been informed that:Heart conditions that may lead to arrhythmias and sudden cardiac arrest include, but are not limited to, electrical conduction abnormalities such as Long QT Syndrome (LQTS), Brugada Syndrome (BrS), and Wolff-Parkinson-White (WPW) Syndrome, and heart muscle abnormalities such as Hypertrophic Cardiomyopathy (HCM), Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), and Dilated Cardiomyopathy (DCM). Patients with these and other heart disorders can have palpitations, shortness of breath, chest pain, fainting episodes, or sudden cardiac arrest as a result of the associated arrhythmias.

The diagnosis of Long QT Syndrome, Hypertrophic Cardiomyopathy and other heart rhythm disorders is made by a thorough evaluation of the patient, including the electrical system of the heart. Part of the assessment includes an electrocardiogram (ECG), which measures the cardiac electrical activity from the surface of the chest through electrodes (adhesive stickers). Once the ECG is performed, the timing intervals of the cardiac cycle can be measured. Patients found to have abnormal electrical activity on their ECG should be evaluated further by a cardiologist. I acknowledge that the screening ECG being performed on my child does not constitute a thorough evaluation of my child.

I understand the ECG is a good screening tool, but can be normal at times in patients with heart disorders such as Long QT Syndrome and Hypertrophic Cardiomyopathy.

Therefore I understand there are limitations to the utility of the ECG, and that it is not a definitive test for the diagnosis.

Alternatively, the ECG can also sometimes show abnormalities in a patient with a completely normal heart. I understand this limitation must be recognized as well, and sometimes prompts additional testing and evaluation until a more definitive clinical decision is made. I also understand that there may be other abnormalities or conditions that are not shown or revealed by an electrocardiogram.

I understand that an abnormal finding on an ECG may result in restrictions being placed on my child’s participation in physical and competitive sports activities.

I understand that I should immediately contact my child’s primary care physician if I am advised of any finding that warrants further evaluation (whether it pertains to Long QT Syndrome, Hypertrophic Cardiomyopathy or another heart-related diagnosis). I also understand that many cardiac conditions are hereditary and that I should also notify my own primary care physician of any findings in my child’s ECG that warrants further evaluation to determine the relevance of such findings to my own health and that of other family members. I understand that follow-up with my child’s physician is my responsibility and not the responsibility of the C.A.R.E. Foundation nor the physicians evaluating my child’s ECG.

I certify that I have read and fully understand the above consent and that all of my questions have been answered to my satisfaction.

Signature of Consenting Party

Date

Printed Name of Parent or Legal Guardian

Relationship to Patient

This consent form and health questionnaire must be completed and presented to receive a free heart screening. Anyone less than 18 years of age must have this form signed by a parent or legal guardian.

Please visit the CARE website at www.CAREforhearts.org

427 Fulton StreetPO Box 69Seymour, WI 54165(800) 404-9500care@careforhearts.orgwww.careforhearts.org

C.A.R.E. Foundation Screening Questionnaire(Must be completed prior to screening)

Name:

Date of Birth:

Parent/Guardian’s Name:

Mailing Address:

Home Phone:

Cell Phone:

Primary Physician’s Name:

Primary Physician’s Phone Number:

Primary Physician’s Mailing Address:

Have you ever had fainting, convulsions, seizures orsevere dizziness? YES NO

Have you ever had chest pain, dizziness, fainting orpassed out after exercise? YES NO

Do you tire more easily or quickly than your friendsduring exercise? YES NO

Have you ever been told you have high blood pressure orhigh cholesterol? YES NO

Have any close relatives had heart problems, heartattack or sudden death before the age of 50?

YES NO

If you answered “YES” to any of these questions,you should see your doctor immediately.

Since 1995, the Cardiac arrhythmias research and education (C.a.r.e.) Foundation has made a significant contributions by funding research, advocating for patients rights and educating the public and healthcare professionals about the risk of sudden cardiac death in all groups. Learn more at www.careforhearts.org

BRING THIS COMPLETED FORM TO THE HEART HEALTH EXPO FOR YOUR FREE HEART SCREENING!