Cardiovascular History 

Yes / No

Do you ever have chest pain?
Y; Started this morning. Pain is dull and achy feeling
Do you ever have shortness of breath?
Y
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?
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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©1998,  Neal R. Chamberlain, Ph.D.. All rights reserved.