Cardiovascular History |
Yes / No |
| Do you ever have chest pain? |
N |
| Do you ever have shortness of breath? |
N |
| Do you get shortness of breath with stair climbing? |
N |
| Do you get chest pain with stair climbing? |
N |
| Do you ever experience ankle swelling? |
N |
| Do you get leg cramps when walking? |
N |
| Do you awaken at night with chest pain? |
N |
| Do you awaken at night with shortness of breath? |
N |
| Do you ever experience irregular or "funny feeling" heart beats? |
N |