Female Questionnaire
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This section is about specific confirmed heart problems.


Have you suffered a stroke-type event?
  • No / don't know
  • Mini-stroke (TIA or brief disturbance)
  • More than one mini-stroke
  • An actual stroke
  • A severe stroke or more than one


Have you experienced Angina?
  • Don't know
  • No / angina ruled out
  • Past episode(s) now resolved
  • Current minor problem
  • Current major problem


Do you suffer from Congestive Heart Failure?
  • No / don't know
  • Moderately
  • Severely


Have you already suffered Heart Attack(s)?
  • Don't know
  • No
  • Yes, mild one
  • Yes, a severe one
  • Yes, more than one


Have you been diagnosed with Atherosclerosis (hardening of the arteries)?
  • Never had it / don't know
  • Probably had it/minor symptoms now resolved
  • Significant symptoms now resolved
  • Current problem
  • Current major problem


Have you had an enlarged artery called an Aneurysm or experienced a ruptured Aneurysm?
  • Don't know
  • No
  • Possible enlargement being watched for progression
  • Yes, may require surgery
  • Yes, ruptured or required surgery


Have you been diagnosed with Vasculitis? This is inflammation of blood vessel(s).
  • Don't know
  • No
  • Yes, in the past, but it is not a current problem
  • Yes, it is a minor recurring problem
  • Yes, it is a serious recurring problem


Have you been diagnosed with Phlebitis or Thrombophlebitis? This is inflammation of a vein, usually in the leg(s), sometimes caused by a blood clot.
  • Don't know
  • No, I do not have this condition
  • Yes, but in the past only - not a current problem
  • Yes, superficial phlebitis
  • Yes, deep vein - thrombophlebitis


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


Have you been diagnosed with Mitral Valve Prolapse?
  • No / don't know
  • Yes
  • Yes, severe


Have you been told that you have a Heart Murmur? This is an extra or unusual sound heard during a heartbeat.
  • Don't know
  • I was tested, but no murmur was detected
  • Detectable, but minor
  • Easily detected
  • Serious / pronounced


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


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