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 FEMALE QUESTIONNAIRE - PAGE 6(j) 

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This section is about heart problems.
678.  Have you experienced angina?
Don't know
No / angina ruled out
Past episode(s) now resolved
Current minor problem
Current major problem
679.  Have you had an irregular heartbeat (arrhythmia)?
No / don't know
In the past only, seems resolved
Occasionally / somewhat
Often / very much so
680.  Have you already suffered heart attack(s)?
Don't know
No
Yes, mild one
Yes, a severe one
Yes, more than one
681.  Do you suffer from congestive heart failure?
No / don't know
Moderately
Severely
682.  Has it been confirmed by a doctor that you have an enlarged heart?
Don't know
No, it is definitely not enlarged
Mildly enlarged / doctor not concerned
Moderately enlarged
Severely enlarged / doctor is very concerned
683.  Have you been diagnosed with mitral valve prolapse?
No / don't know
Yes
Yes, severe
684.  Have you been told that you have a heart murmur?
Don't know
I was tested, but no murmur was detected
Detectable, but minor
Easily detected
Serious / pronounced
685.  Have you been diagnosed with cardiomyopathy? This is a potentially serious disease in which the heart muscle becomes weakened or enlarged and the heart is often dilated.
Don't know
No
Yes, but the condition is currently mild
Yes, condition is concerning but not advanced
Yes, I am close to heart failure
686.  Have you been diagnosed with myocarditis?
Don't know
No, there is no heart inflammation
Yes, but it is now resolved
Yes, there is mild inflammation
Yes, it is serious / chronic inflammation

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GLOSSARY

Angina
Angina Pectoris: Severe, restricting chest pain with sensations of suffocation caused by temporary reduction of oxygen to the heart muscle through narrowed diseased coronary arteries. Often triggered by exertion. Angina Vasomotoria: Like the previous, but less dangerous and more frequently caused by purely neurologic stimulus. The pain is more spasmodic and there is usually little actual blood vessel blockage.

Arrhythmia (Arrhythmias)
A condition caused by variation in the regular rhythm of the heartbeat. Arrhythmias may cause serious conditions such as shock and congestive heart failure, or even death.

Congestive
Pertaining to accumulation of blood or fluid within a vessel or organ.

Myocarditis
Inflammation of heart muscle. It can be mild, with virtually no noticeable symptoms, or more serious, leading to weakening of the heart muscle. It can then cause heart failure (with symptoms of shortness of breath, fatigue, fluid accumulation in the lungs, etc.) as well as heart rhythm irregularities from inflammation and/or scarring of the electrical system of the heart.





























 

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