Do you ever get any symptoms like the ones shown above when walking couple of minutes on level ground or climbing one flight of stairs at a normal pace ?

YesNo

Do you feel that these symptoms limit your activities of daily living such as household chores, shopping or leisure ?

YesNo

Do you ever get these symptoms at rest, after eating, or just watching television ?

YesNo

Do you ever awaken at night with these symptoms ?

YesNo

Have you decreased your activity in the past 6 months due to these symptoms ?

YesNo

Do you avoid activity because you might get these symptoms ?

YesNo

Do you take nitroglycerin tablets before certain activities to prevent these symptoms ?

YesNo

Are you dissatisfied with your current quality of life because of lack of energy, symptoms, or inability to engage in your normal activities of daily living ?

YesNo

Have you ever had bypass surgery ?

YesNo

Have you ever had an angioplasty or a stent ?

YesNo