Heart Health Assessment
Comprehensive cardiovascular risk evaluation powered by AI
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Personal Information
Full Name *
Age *
Gender *
Select gender
Weight (kg) *
Height (cm) *
Waist Circumference (cm)
Location
Detect
Vital Signs
Systolic Blood Pressure (mmHg) *
Diastolic Blood Pressure (mmHg) *
Resting Heart Rate (bpm) *
Temperature (°F)
Oxygen Saturation (%)
Cardiac Symptoms Assessment
Cardiac Symptoms (Check all that apply)
Chest pain or discomfort
Shortness of breath
Palpitations (irregular heartbeat)
Unusual fatigue
Dizziness or lightheadedness
Swelling in legs, ankles, or feet
Cardiovascular Risk Factors
Smoking status
No
Former smoker
Current smoker
Alcohol consumption
No
Light (1-7 drinks/week)
Moderate (8-14 drinks/week)
Heavy (15+ drinks/week)
Drinking pattern
Do you have diabetes?
No
Pre-diabetes
Yes
Do you have high blood pressure (hypertension)?
No
Yes
Cholesterol levels
No
Borderline high
High
Don't know
Family history of heart disease (parents, siblings, children)
No
Yes
Lifestyle Assessment
Physical activity level
Sedentary (little to no exercise)
Light activity (1-2 days/week)
Moderate activity (3-4 days/week)
Very active (5+ days/week)
Exercise frequency and duration
Types of exercise
Diet quality
Excellent (Mediterranean/DASH style)
Good (mostly healthy foods)
Fair (mixed healthy and unhealthy)
Poor (mostly processed/fast foods)
Describe your typical diet
Stress level
Low
Moderate
High
Very High
Describe your main sources of stress
Sleep quality
Excellent (7-9 hours, restful)
Good (6-8 hours, mostly restful)
Fair (5-7 hours, sometimes restless)
Poor (<6 hours or frequently restless)
Average hours of sleep per night
Medical History
Have you ever had a heart attack?
No
Yes
Have you had any heart surgery or cardiac procedures?
No
Yes
Are you currently taking any medications?
No
Yes
Do you have any drug allergies?
No
Yes
Recent Medical Tests
Have you had a recent ECG/EKG?
No
Yes
Have you had a recent echocardiogram?
No
Yes
Have you had recent blood tests?
No
Yes
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