Questionnaire - Page 6(d) of 9
(1014 maximum possible questions)		 Last updated: May 05, 2008

THE ANALYST TM
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This section deals with chest discomfort.
657.  Do you experience any chest pain?
No / don't know
Yes, I can touch the tender area
Yes, It is deep in my chest
Yes, it radiates to back, neck, jaw or arm
658.  Do you tend to get or have problems with chest pressure, but not outright pain?
Don't know
No
Occasionally / moderately
Often / severely
659.  Do you experience tightness - a general constricting sensation - in your chest?
Don't know
No
Rarely
Frequently
Most of the time
660.  Do you experience pain when breathing?
Don't know
No
In the past only
Mild discomfort
Moderate / severe pain
661.  If you experience 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
662.  If you experience chest pain or tightness, how is it affected by exertion?
Don't know
Pain is unrelated to exertion
Possibly associated with exertion
Definitely associated with exertion
Pain is always felt upon exertion
663.  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
664.  Do you have difficulty breathing that is unrelated to pain, discomfort or other symptom? It just seems like it is harder to breath.
Don't know
No
Possibly
Yes, an intermittent problem
Yes, a frequent problem

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