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Self-assessment Cardiovascular


Heart disease is easier to treat when it’s found early.
The questionnaire presented below will help you identify your cardiovascular risk.

    Patient Information

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    Self-Assessment

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    Chest pain or pressure / discomfort in the chestChest pain during physical activityChest pain due to emotional stressShortness of breathRapid heartbeat (tachycardia)Slow heartbeat (bradycardia)Shortness of breath while walking or sleepingLeg swellingDizziness or lightheadednessFainting (syncope)

    DiabetesHypertensionObesityDyslipidemia

    YesNo

    ParentsSiblingsOther