Cardiac Tool

1) What is your age?

Answer:

age

2) What is your weight?

Answer (in kg) :

3) Is your BMI greater than 25?

Yes No

4) Do you have family history of Hypertension?

Yes No

5) Do you have high Blood Pressure?

Yes No

6) Do you have a family history of Heart Disease?

Yes No

7) What is your pulse rate?(72 beats/minute is normal)

Answer:

8) Do you have family history of Diabetes?

Yes No

9) What are your blood sugar levels? (normal fasting sugar 100mg/100ml)

Answer:

10) Do you suffer from cholesterol?

Yes No

11) What is your cholesterol value?(Cholesterol 200mg/ 100 ml of blood is within normal limits)

Answer:

12) Do you have high trigylcerides?

Yes No

13) What are your triglyceride levels?(150mg/100ml is normal limits)

Answer:

14) Do you feel that you are short of breath, have chest pain, palpitation, or giddiness fairly soon during any activity?

Yes No

15) Have you ever found to have high heart rate?eg. during any illness activity, or exertion

Yes No

16) Do you often feel stressed,depressed,irritated or have mood swings?

Yes No

17) Do you lead a sedentary life style?

Yes No

18) Are you increasingly gaining weight recently?

Yes No

19) Do you take more than average salt?

Yes No

20) Do you regularly eat sweets, items of Maida, junk food, Canned fruit juices, cold drinks etc.

Yes No

21) Do you consume Alcohol at least 4 times a week?

Yes No

22) Do you smoke?

Yes No

23) Do you sleep for an average of 7 hours?

Yes No

24) Measure your waist circumference For Adult Male – Do you have a waist circumference greater than 94 cm? For Adult Female -– Do you have a waist circumference greater than 80 cm?

Yes No