Cardiovascular History 

Yes / No

Do you ever have chest pain?
Y; During coughing spells 5 weeks ago.
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 

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©1999,  Herbert A. Yates, D.O. and Neal R. Chamberlain, Ph.D.. All rights reserved.