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20 - 30 years
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31 - 45 years
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46 - 55 years
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> 55 years
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Gender
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Male
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Female
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If female, then
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Regular menstrual periods
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Irregular menstrual periods
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Menopausal period
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Post Menopausal period
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Asian
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Asian American
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American
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African
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European
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Others |
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Have you experienced any of these
complaints?
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Increased heart rate (palpitation)
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Breathlessness on mild exertion
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Breathlessness at rest all the time
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Swelling of ankles, feet or legs
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Constant headache
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Pain in chest on exertion
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Pain in chest (when at rest)
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None of the above
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| |
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Yes
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No
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Any family history of heart
attack, stroke or any other cardiac disease
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|
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None
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More than one relative having the problem
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A relative has had the problem at the age,
more than 55 yrs. of age.
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A relative has had the problem at the age,
less than 55 yrs. of age.
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Death due to sudden cardiac arrest
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Tell me your recent Blood pressure
readings
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Systolic (first
reading)
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mm/ Hg
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Diastolic
(second reading)
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mm/ Hg
|
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Has your doctor advised you to get your Lipid Profile checked?
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Yes
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No
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If Yes, then
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Total Cholesterol (in mg/dl)
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< 250
251 - 350
351 - 400
> 400
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HDL (good cholesterol)
(in mg/dl)
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< 35
35 - 60
> 60
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LDL (bad cholesterol)
(in mg/dl)
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< 130
131 - 159
> 159
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Triglycerides
(in mg/dl)
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< 160
161 - 250
> 250
|
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How about Smoking?
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Smoke less than 20 a day
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Smoke more than 20 a day
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Quit Smoking (less than 5 years)
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Quit Smoking (more than 5 years)
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Never Smoked
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How often do you exercise?
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Regularly for atleast 25 min.
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4 times a week for atleast 25 min.
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Once or twice a week
|
Irregular
|
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As per your height, you are
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Normal Weight
|
Over Weight (about 10% more than normal weight )
|
|
Obese
|
|
| Calculate your BMI |
| |
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How stressed are you?
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competitive, hard driving, alert, work under pressure (type
A personality)
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Easy going, less competitive, calm (type B personality)
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Any other personality
|
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Thanks for taking time to fill the details. |
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Now all you have to do is press submit and I will calculate how much you are at risk. Best of Luck!
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