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 MALE QUESTIONNAIRE - PAGE 6(a) 

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This section deals with chest discomfort.
639.  Do you experience chest pain? Do not include pressure or tightness.
No / don't know
Yes, I can touch the tender area
Yes, it is deep in my chest
Yes, it radiates to back, neck, jaw or arm
640.  If you experience chest pain, how would you rate its severity?
Not applicable / don't know
A minor sensation
Significant
Very significant
Severe, almost unbearable
641.  Do you experience pain when breathing?
Don't know
No
In the past only
Mild discomfort
Moderate / severe pain
642.  If you experience chest pain, how is it affected by breathing?
Don't know
The pain is unrelated to breathing
It is worse only when I breathe in deeply
It is worse only when I breathe out deeply
It is worse when I breathe in or out
643.  Do you tend to get or have problems with chest pressure? Do not include pain or tightness.
Don't know
No
Occasionally / moderately
Often / severely
644.  Do you experience tightness in your chest? Do not include pain or pressure.
Don't know
No
Rarely
Frequently
Most of the time
645.  Have you had an aching or burning sensation behind your breastbone (top-middle chest)?
Never had it / don't know
Probably had it/minor episode(s) now resolved
Major episode(s) now resolved
Current minor problem
Current major problem

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