FKRP-related muscular dystrophy — encompassing the common LGMD R9 adult-onset phenotype (previously LGMD 2I, OMIM #607155) and the severe congenital MDC1C form (OMIM #606612) — is caused by biallelic pathogenic mutations in FKRP (fukutin-related protein gene, chromosome 19q13.32), encoding fukutin-related protein, a glycosyltransferase enzyme localized to the Golgi apparatus that catalyzes the O-mannose-linked glycosylation of alpha-dystroglycan, a critical peripheral membrane glycoprotein that forms a central structural link in the dystrophin-associated glycoprotein complex (DAGC) spanning the sarcolemma from the intracellular cytoskeleton to the extracellular matrix; alpha-dystroglycan must be heavily glycosylated with a laminin-binding O-mannosyl sugar chain — including matriglycan, the terminal repeating xylose-glucuronate disaccharide polymer — to bind extracellular matrix ligands including laminin-211 and perlecan in basement membranes, agrin at neuromuscular junctions, and neurexin in the central nervous system; when FKRP is absent or dysfunctional, the glycosylation of alpha-dystroglycan is reduced or abolished, the matriglycan chain is not assembled, laminin binding is lost, the DAGC scaffold is destabilized, and sarcolemmal membrane integrity is compromised during muscle contraction, resulting in progressive muscle fiber degeneration — a pathomechanism shared with multiple other dystroglycanopathy disorders (caused by mutations in POMGNT1, POMT1, POMT2, POMGNT2, GTDC2, FKTN, LARGE1, and other glycosylation pathway genes) that together constitute the dystroglycanopathies, with FKRP mutations being the most common genetic cause of adult-onset dystroglycanopathy in northern European populations; the clinical spectrum of FKRP mutations spans two dramatically different severity extremes determined largely by the degree of residual FKRP glycosyltransferase activity: (1) LGMD R9 — the common mild-to-moderate adult-onset form caused by biallelic mutations retaining some residual FKRP activity, most frequently the p.Leu276Ile (c.826C>A) founder mutation that is present in homozygous form or as a compound heterozygote in the majority of northern European LGMD R9 patients — presents in the second to fourth decade with proximal limb girdle weakness affecting the pelvic girdle and thighs, progressive difficulty with stairs and rising from the floor, shoulder girdle involvement that follows pelvic girdle involvement, elevated CK (10 to 50 times normal), and a natural history ranging from mild disability to wheelchair use in middle adulthood; (2) MDC1C — the severe congenital form caused by biallelic null mutations completely abolishing FKRP function — presents in the neonatal period with profound hypotonia, early respiratory failure, dilated cardiomyopathy, structural brain involvement (cobblestone lissencephaly, cerebellar hypoplasia, hydrocephalus), and intellectual disability, representing the most severe end of the FKRP clinical spectrum; a critically important clinical feature of LGMD R9 that distinguishes it from many other LGMD subtypes and demands dedicated care platform attention is cardiac involvement — dilated cardiomyopathy (DCM) occurs in a clinically significant proportion of LGMD R9 patients, estimated at 20–40% in longitudinal cohort studies, and this FKRP-associated dilated cardiomyopathy can precede skeletal muscle weakness, can be severe and rapidly progressive, and is a major cause of FKRP-related morbidity and mortality; the cardiac involvement is not universal and its relationship to genotype is incompletely predictable, making annual cardiac surveillance mandatory and cardiac monitoring platforms a first-class clinical priority in LGMD R9 care; respiratory involvement is another major morbidity domain — respiratory muscle weakness causing restrictive ventilatory failure with FVC decline is a primary cause of LGMD R9 morbidity, and respiratory failure — often requiring nocturnal and then continuous non-invasive ventilation — is a leading cause of death in patients with more severe LGMD R9 phenotypes; muscle biopsy showing reduced or absent alpha-dystroglycan glycosylation by immunohistochemistry with VIA4-1 or IIH6 antibodies (which recognize the matriglycan epitope required for laminin binding) is the diagnostic biomarker for dystroglycanopathy, and in FKRP-LGMD R9 the reduced alpha-dystroglycan staining pattern with appropriate clinical and molecular features confirms the diagnosis before genetic testing results are available; diagnosis is confirmed by biallelic FKRP pathogenic variants on gene panel sequencing, with p.Leu276Ile homozygosity being pathognomonic in the appropriate clinical context.
FKRP-related muscular dystrophy technology platforms — covering the neuromuscular and cardiology platforms through which patients with proximal limb girdle weakness, extreme CK elevation, and cardiac risk enter the diagnostic pathway and longitudinal care, the cardiac surveillance platforms scheduling the annual echocardiogram and ECG monitoring that are mandatory given the significant cardiomyopathy prevalence and the life-threatening nature of FKRP-associated DCM, the respiratory function tracking platforms generating the serial FVC and spirometry records that guide NIV initiation decisions in a disease where respiratory failure is a primary mortality cause, the cardiac medication adherence platforms monitoring ACE inhibitor and beta-blocker therapy initiated for FKRP-associated DCM and the ICD device management platforms for patients who have received implantable defibrillators for arrhythmia prevention, the muscle function tracking platforms generating timed motor test and NSAA records that document functional trajectory and trial eligibility, the alpha-dystroglycan immunostaining record platforms documenting the reduced glycosylation diagnostic biomarker result from muscle biopsy, the physiotherapy coordination platforms scheduling exercise programs, the walking aid prescription platforms tracking progression, and the genetic counseling platforms coordinating FKRP biallelic variant counseling and family planning — must maintain the availability and performance that cardiac surveillance, respiratory monitoring, cardiac medication adherence, and functional assessment require. This guide explains why FKRP-LGMD R9 care tech platforms require specialized monitoring, what to monitor, and how to build a monitoring strategy calibrated to the cardiac risk, respiratory involvement, and clinical complexity of FKRP-related muscular dystrophy.
Why FKRP-LGMD R9 Tech Platforms Require Specialized Monitoring Attention
FKRP-related muscular dystrophy presents platform dependencies centered on cardiac surveillance and respiratory monitoring — the two domains where platform failures carry the most direct patient safety consequences in a disease where cardiomyopathy can be severe and respiratory failure is a leading cause of death.
Cardiac surveillance platforms carry the highest-priority monitoring obligation in LGMD R9 because FKRP-associated DCM is life-threatening and occurs in a substantial patient fraction. Dilated cardiomyopathy complicates LGMD R9 in an estimated 20–40% of patients, can present at any time in the disease course, may precede skeletal muscle weakness, and once established requires early treatment with ACE inhibitors and beta-blockers — and ICD implantation when arrhythmia risk is high — to reduce sudden cardiac death risk. Annual echocardiogram and ECG surveillance is mandatory in LGMD R9; the surveillance platform that fails during a cardiology scheduling workflow means that a patient's annual echocardiogram is not booked, a new LVEF reduction to 38% is not detected at the appropriate interval, ACE inhibitor therapy is not initiated, and the patient develops symptomatic heart failure six months later that could have been treated with earlier detection. Monitor cardiac surveillance platforms 24/7.
Respiratory function tracking platforms detect the progressive FVC decline that precedes life-threatening ventilatory failure. Respiratory involvement in LGMD R9 is common in more severely affected patients, with FVC declining progressively as respiratory muscles weaken; NIV initiation at FVC below 60% predicted (or when nocturnal hypoventilation is documented on overnight oximetry or capnography) prevents respiratory failure and extends life. Serial FVC records generate the longitudinal respiratory trajectory that determines the NIV initiation decision. Platform failures creating gaps in FVC records delay the threshold-triggered NIV referral that is a life-saving intervention. Monitor during clinical hours and for advanced patients with NIV planning, around the clock.
Cardiac medication adherence platforms monitor the ACE inhibitor and beta-blocker therapy that reduces FKRP cardiomyopathy progression. Once FKRP-associated DCM is established, guideline-directed medical therapy — ACE inhibitors or ARBs for afterload reduction and beta-blockers for cardiac remodeling prevention — requires ongoing adherence monitoring, dose titration records, and blood pressure and heart rate tracking to confirm therapeutic targets. Platform failures interrupting medication adherence records prevent the care team from identifying non-adherence, missed titrations, or drug intolerances that accelerate cardiomyopathy progression. Monitor during clinical hours.
ICD and device management platforms track the implantable devices placed for FKRP arrhythmia prevention. Patients with FKRP-associated DCM and high arrhythmia risk may receive ICDs for sudden cardiac death prevention; device management platforms tracking device settings, remote monitoring data, appropriate shocks, inappropriate shocks, battery status, and device clinic attendance records are critical patient safety systems. ICD platform failures create gaps in arrhythmia monitoring records. Monitor 24/7 for remote ICD monitoring platforms.
Longitudinal muscle function tracking platforms generate the trajectory data required for trial eligibility and natural history characterization. FKRP-LGMD R9 clinical trials are in development; timed motor test, NSAA, dynamometry, and 6-minute walk test records documenting functional trajectory are the eligibility and baseline datasets. Monitor during clinical hours.
What to Monitor on an FKRP-LGMD R9 Care Tech Platform
Cardiac Surveillance Records
Monitor echocardiogram scheduling records confirming that annual cardiac imaging is booked and completed for every LGMD R9 patient — not only those with known cardiomyopathy but all patients given the substantial prevalence; echocardiogram report records documenting left ventricular ejection fraction (LVEF), left ventricular dimensions (LVEDD, LVESD), wall motion, diastolic function, and comparison with prior studies; LVEF alert records triggering immediate cardiology referral when LVEF drops below 50% (borderline impairment) or below 40% (moderate impairment — immediate treatment initiation); annual ECG records for rhythm documentation (sinus rhythm versus arrhythmia), conduction interval measurement (QRS duration — bundle branch block), and comparison with prior ECGs; Holter or cardiac event monitor records for patients with palpitations, pre-syncope, or ECG abnormalities; cardiology clinic attendance records documenting review of cardiac findings by a cardiologist with heart muscle disease expertise; cardiac imaging modality variation records (cardiac MRI for patients where echocardiogram windows are limited — late gadolinium enhancement providing fibrosis quantification); cardiomyopathy staging records documenting NYHA functional class; and new-onset symptomatic arrhythmia emergency alert records. Alert on cardiac surveillance platform failures immediately, around the clock for ICD monitoring.
Respiratory Function Surveillance
Monitor serial spirometry records documenting FVC (litres and percent predicted), FEV1, FEV1/FVC ratio at annual or biannual intervals — more frequently as FVC declines toward the 60% threshold; FVC trajectory records tracking the rate of FVC decline per year (faster decline rates — more than 2–3% per year absolute — predict earlier NIV need and indicate accelerating respiratory muscle involvement); FVC threshold alert records triggering NIV assessment referral when FVC falls below 60% predicted or when the patient reports orthopnoea, morning headaches, or daytime somnolence suggesting nocturnal hypoventilation; overnight pulse oximetry records for patients with FVC 50–70% predicted (hypoxaemia screening); capnography records for CO2 retention assessment; NIV device initiation records documenting the date and settings of first NIV prescription; NIV adherence monitoring records (hours per night from device download); NIV settings adjustment records as disease progresses; cough peak flow records for patients requiring cough augmentation (cough assist device or manual-assisted cough); and respiratory physiotherapy records for patients with secretion retention. Monitor during clinical hours, with NIV remote monitoring available around the clock.
Cardiac Medication Adherence Records
Monitor ACE inhibitor (enalapril, ramipril, lisinopril, perindopril) or ARB (losartan, candesartan) prescription and dispensing records for patients with FKRP-associated DCM; dose titration records documenting progression from initiation dose to target dose; blood pressure monitoring records confirming adequate dosing without hypotension; beta-blocker (bisoprolol, carvedilol, metoprolol succinate) prescription and dispensing records; heart rate monitoring records confirming target heart rate achievement; medication refill records flagging gaps indicating non-adherence; adverse effect records documenting cough, hypotension, or bradycardia requiring dose adjustment; and pharmacy interaction records for patients on multiple cardiac medications. Monitor during clinical hours.
ICD and Device Management Records
Monitor ICD implant records documenting implant date, device model, lead configuration, and primary/secondary prevention indication; remote monitoring transmission records — most modern ICDs transmit daily remote monitoring data including arrhythmia logs, therapy delivery records, and battery status; appropriate ICD shock records (documentation of ventricular arrhythmia treated by ICD therapy — requires urgent cardiology review); inappropriate ICD shock records (ICD therapy delivered for non-ventricular arrhythmia — requires device programming review to prevent recurrence); device clinic attendance records for periodic in-person device checks; battery status alert records when ICD battery approaches replacement threshold (typically within 3 months of projected replacement); and pacemaker records for patients with complete heart block or sick sinus syndrome requiring pacing. Monitor ICD remote monitoring platforms 24/7.
Muscle Strength and Functional Assessment Records
Monitor dynamometry records at each clinic visit documenting hip flexor, hip extensor, hip abductor, quadriceps, hamstring, knee flexor, knee extensor, shoulder abductor, and elbow flexor strength; NSAA (North Star Ambulatory Assessment) or GFAQ functional scale records; timed motor function tests including 10-meter walk time, time to rise from floor, 4-stair climb time, and timed up-and-go; 6-minute walk test distance records; upper limb motor test records; and non-ambulatory patient functional assessment records (performance of upper limb — PUL; respiratory and cardiac functional status — more relevant in non-ambulatory LGMD R9 patients). Monitor during clinical hours.
Serum CK and Biomarker Monitoring
Monitor serum CK records at every clinical contact — CK is typically 10 to 50 times normal in LGMD R9; baseline CK value and longitudinal trend; liver function records for AST and ALT (muscle-origin elevation); and novel plasma biomarker result records (creatine, myosin heavy chain, NfL) for trial participants. Monitor during clinical hours.
Alpha-Dystroglycan Immunostaining and Molecular Diagnostic Records
Monitor alpha-dystroglycan immunohistochemistry result records from muscle biopsy documenting reduced or absent staining with VIA4-1 and IIH6 antibodies (matriglycan-recognizing antibodies); normal laminin alpha-2 staining records (confirming FKRP-LGMD rather than LAMA2-CMD); FKRP biallelic pathogenic variant records confirming both pathogenic alleles with ACMG/AMP variant classification — including p.Leu276Ile (c.826C>A) homozygous or compound heterozygous genotype documentation; muscle biopsy histopathology records (H&E — myopathic changes; inflammatory infiltrates possible); and genetic counseling records for autosomal recessive inheritance counseling (25% recurrence risk; partner carrier testing; sibling testing). Monitor during clinical hours.
Gait Analysis and Walking Aid Progression
Monitor gait analysis records characterizing hip girdle weakness pattern (Trendelenburg gait — bilateral or predominantly affected side; forward trunk lean at initial contact from hip extensor weakness), walking aid progression records tracking cane, rollator, and powered wheelchair transitions, ankle-foot orthosis records if foot drop develops in advanced disease, falls risk assessment records, and occupational therapy home modification records. Monitor during clinical hours.
Authentication and Clinical Access
Monitor authentication at 1-minute intervals, 24/7. FKRP-LGMD R9 multidisciplinary teams spanning neuromuscular specialists, cardiologists with heart muscle disease expertise, respiratory physicians, cardiac physiologists performing echo and Holter monitoring, ICD device nurses, respiratory physiotherapists, physiotherapists for skeletal muscle conditioning, genetic counselors, and trial coordinators require concurrent platform access during complex longitudinal visits where cardiac results, FVC trends, medication adherence, and functional trajectory data are reviewed together.
SSL Certificates
Monitor SSL certificate expiry across cardiac surveillance platforms, ICD remote monitoring portals, respiratory monitoring applications, medication adherence systems, FKRP molecular diagnostic record platforms, muscle function tracking systems, and trial eligibility platforms. Certificate errors in ICD remote monitoring or cardiac surveillance systems carry the highest immediate patient safety urgency.
HIPAA and FKRP Genetic Disease Patient Privacy Considerations
FKRP-related muscular dystrophy technology platforms handle PHI categories including FKRP biallelic pathogenic variant identification records with GINA protections, echocardiogram and cardiac imaging records documenting cardiomyopathy severity, ICD implant and therapy delivery records, cardiac medication prescription records, serial FVC records documenting respiratory decline trajectory, NIV adherence monitoring records, clinical trial participation records, alpha-dystroglycan immunostaining diagnostic records, and genetic counseling records. HIPAA Security Rule protections apply across all platform components, with particular attention to cardiac device records, respiratory monitoring data, and genetic variant documentation.
Alerting Strategy for FKRP-LGMD R9 Tech Platforms
Immediate 24/7 alerting: Authentication; ICD remote monitoring platform failures; acute cardiac arrhythmia or ICD shock alert systems.
Immediate clinical-hours alerting: LVEF drop below threshold triggering cardiology referral; FVC threshold alerts triggering NIV assessment; new ECG abnormality alert systems; trial eligibility and visit window alerts during open enrollment windows.
Sustained-failure alerting (10–15 minutes): Cardiac surveillance scheduling and echo reporting platforms; cardiac medication adherence monitoring; respiratory function surveillance and spirometry platforms; NIV adherence monitoring; muscle strength and functional assessment tracking; CK trend monitoring; physiotherapy coordination; walking aid progression; alpha-dystroglycan and FKRP molecular diagnostic record systems.
30-day advance warning: SSL certificates across all domains.
Vigilmon's multi-region monitoring confirms FKRP-LGMD R9 platform availability from the geographies where neuromuscular disease centers with FKRP expertise, cardiomyopathy-capable neuromuscular teams, respiratory neuromuscular programs, and FKRP clinical trial sites serve patients with a limb girdle muscular dystrophy whose cardiac and respiratory complications can be life-threatening.
Status Page for FKRP-LGMD R9 Care Team Communication
A real-time status page gives neuromuscular specialists coordinating cardiac and respiratory surveillance, cardiologists monitoring FKRP-associated DCM, ICD device nurses managing remote monitoring, respiratory physicians tracking FVC trends, physiotherapists coordinating conditioning programs, genetic counselors managing FKRP family counseling, and families navigating a progressive muscular dystrophy with life-threatening cardiac and respiratory complications immediate platform visibility without requiring IT support contact.
Include the status page URL in neuromuscular clinic emergency procedures, cardiac device clinic emergency contacts, NIV service contacts, and trial coordinator communication protocols.
Vigilmon Setup for FKRP-LGMD R9 Tech Platforms
A practical starting configuration:
| Monitor | Check Interval | Alert Channel | |---------|----------------|---------------| | Authentication | 1 min | Slack + PagerDuty (24/7) | | ICD remote monitoring platform | 1 min | Slack + PagerDuty (24/7) | | LVEF threshold alert (cardiology referral trigger) | 1 min | Slack + PagerDuty (clinical hours) | | Respiratory FVC threshold alerts | 1 min | Slack + PagerDuty (clinical hours) | | Trial eligibility and visit window alerts | 1 min | Slack + PagerDuty (clinical hours) | | Echocardiogram scheduling and reporting | 2 min | Slack (clinical hours) | | Annual ECG scheduling and reporting | 2 min | Slack (clinical hours) | | Holter / event monitor platforms | 2 min | Slack (clinical hours) | | Cardiology clinic attendance tracking | 2 min | Slack (clinical hours) | | Cardiac medication adherence (ACE inhibitor / beta-blocker) | 2 min | Slack (clinical hours) | | ICD battery status alerts | 2 min | Slack (clinical hours) | | Serial spirometry and FVC tracking | 2 min | Slack (clinical hours) | | Overnight oximetry and capnography | 2 min | Slack (clinical hours) | | NIV device adherence monitoring | 2 min | Slack (clinical hours) | | Muscle strength and functional assessment tracking | 2 min | Slack (clinical hours) | | 6-minute walk test and timed motor tests | 2 min | Slack (clinical hours) | | NSAA / GFAQ functional scale records | 2 min | Slack (clinical hours) | | CK trend monitoring | 2 min | Slack (clinical hours) | | Physiotherapy scheduling and attendance | 2 min | Slack (clinical hours) | | Walking aid prescription and progression | 2 min | Slack (clinical hours) | | Alpha-dystroglycan and FKRP diagnostic records | 2 min | Slack (lab hours) | | Patient portal / family communication | 2 min | Slack (extended hours) | | SSL: all domains | Daily | Email (30-day warning) |
Getting started:
- Create a free account at vigilmon.online
- Add authentication endpoints at 1-minute intervals with 24/7 PagerDuty alerting
- Configure ICD remote monitoring platforms with 24/7 alerting — highest priority
- Add LVEF threshold alerts with immediate clinical-hours alerting
- Configure respiratory FVC threshold alerting
- Add trial eligibility matching and visit window alert platforms
- Configure echocardiogram scheduling and reporting with sustained-failure alerting
- Add annual ECG scheduling and reporting platforms
- Configure cardiac medication adherence monitoring for ACE inhibitors and beta-blockers
- Add ICD battery status alert platforms
- Configure serial spirometry and FVC tracking with sustained-failure alerting
- Add NIV device adherence monitoring platforms
- Configure muscle strength and functional assessment tracking
- Add 6-minute walk test and timed motor test records
- Configure CK trend monitoring platforms
- Add physiotherapy coordination and attendance tracking
- Configure alpha-dystroglycan immunostaining and FKRP molecular diagnostic record platforms
- Enable SSL certificate monitoring across all cardiac, respiratory, neuromuscular, and trial platforms
- Add the status page URL to neuromuscular clinic emergency procedures, cardiac device clinic protocols, and NIV service contacts
Conclusion
FKRP-related muscular dystrophy technology platforms operate in the context of a limb girdle muscular dystrophy where the cardiac and respiratory complications are not background comorbidities but primary drivers of morbidity and mortality — where the annual echocardiogram that detects LVEF reduction from 65% to 41% in a 34-year-old man with homozygous p.Leu276Ile FKRP mutations is the clinical platform event that triggers the ACE inhibitor and beta-blocker initiation that prevents progression to end-stage heart failure, and where the FVC serial record for a 42-year-old woman with compound heterozygous FKRP mutations that shows decline from 74% to 58% predicted over three years is the dataset that triggers the NIV referral that prevents the hypercapnic respiratory crisis that would otherwise bring her to the intensive care unit; the cardiac surveillance platform that fails during the scheduling workflow for a 31-year-old FKRP-LGMD R9 patient's annual cardiology review means that his echocardiogram is not booked, a new LVEF reduction to 34% — well below the threshold for ACE inhibitor therapy — is not detected in the month when it would have been found, the cardiomyopathy progresses for another six months on a non-treated trajectory, and when he presents to the emergency department with dyspnoea on minimal exertion and bilateral ankle oedema his LVEF has fallen to 22% and he requires urgent heart failure admission that the annual echocardiogram would have prevented by triggering treatment at the earlier stage; an ICD remote monitoring platform that fails for 72 hours means that the ventricular tachycardia episode that occurred on a Tuesday evening — treated appropriately by the ICD with a successful shock restoring sinus rhythm — is not visible to the device care team until the transmission resumes three days later, the urgent cardiology review that the shock record should have triggered is delayed, and the antiarrhythmic medication adjustment that prevents the next episode is not made in time to prevent a second VT episode at the weekend that requires emergency department attendance; a respiratory function platform that fails to integrate the serial FVC record showing that a patient's FVC has fallen from 71% to 53% predicted over the 18 months since the prior measurement means that the clinical threshold for NIV referral has been crossed without the care team's awareness, the NIV assessment that should have been triggered at FVC below 60% is not initiated, and the patient develops nocturnal hypoxaemia and morning headaches that are attributed to poor sleep for two months before a chance clinical review identifies the FVC decline and initiates NIV in the context of already-established nocturnal hypoventilation; and a cardiac medication adherence platform that fails to flag a 60-day gap in ACE inhibitor dispensing for a 45-year-old woman with FKRP-associated DCM means that her left ventricular remodeling continues for two months without the afterload reduction that was preventing further LVEF deterioration, and her follow-up echocardiogram six months later shows LVEF reduction from 45% to 37% that may be partly attributable to the medication gap that the platform failed to detect. These failures are not abstract system reliability concerns — they are the specific failure modes of a care platform for a disease where cardiomyopathy occurs in one in three patients, where the cardiac platform that fails to schedule or alert on the annual echocardiogram is withholding the one investigation that identifies treatable cardiomyopathy before it becomes life-threatening.
Uptime monitoring gives FKRP-LGMD R9 care tech teams the detection capability to identify platform failures within seconds, activate clinical downtime procedures that protect cardiac surveillance scheduling, ICD monitoring, respiratory tracking, and medication adherence record continuity during outages, and demonstrate to neuromuscular disease centers with FKRP expertise, cardiomyopathy-capable muscular dystrophy teams, and families navigating a muscular dystrophy with serious cardiac risk that platform reliability matches the vigilance that FKRP-associated cardiomyopathy demands.
Start monitoring your FKRP-LGMD R9 care tech platform for free at vigilmon.online — HTTP/HTTPS monitoring, multi-region consensus alerting, SSL certificate monitoring, automatic status page, Slack and webhook alerts. No agent required. No credit card.
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