Male Questionnaire
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This section deals with chest discomfort.


Do you experience tightness or pressure in your chest? Do not mention pain here.
  • Don't know
  • No
  • Rarely
  • Frequently
  • Most of the time


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 my back, neck, jaw or arm


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


Do you experience pain that only occurs when you breathe?
  • Don't know
  • No
  • In the past only
  • Yes, mild discomfort
  • Yes, moderate / severe pain


If you are experiencing 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


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