Questionnaire - Page 6(j) of 9
(1078 maximum possible questions)		 Last updated: Oct 09, 2008

THE ANALYST TM
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This section is about heart problems.
703.  Have you experienced angina?
Don't know
No / angina ruled out
Past episode(s) now resolved
Current minor problem
Current major problem
704.  Have you been diagnosed with an arrhythmia?
Don't know
No, none present
Paroxysmal atrial tachycardia
Paroxysmal / constant atrial fibrillation
Ventricular tachycardia / fibrillation
705.  Have you had an irregular heartbeat (arrhythmia)?
No / don't know
In the past only, seems resolved
Occasionally / somewhat
Often / very much so
706.  Have you already suffered heart attack(s)?
Don't know
No
Yes, mild one
Yes, a severe one or had Bypass surgery
Yes, more than one or more than one Bypass surgery
707.  Do you suffer from congestive heart failure?
No / don't know
Moderately
Severely
708.  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
709.  Have you been diagnosed with mitral valve prolapse?
No / don't know
Yes
Yes, severe
710.  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
711.  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
712.  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
713.  Have you been diagnosed with pericarditis?
Don't know
No, there is no inflammation around the heart
Yes, but it is now resolved
Yes, there may be lingering inflammation
Yes, current case of pericarditis

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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.

Arrhythmia:  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.



 


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