Survey
1) What is your most bothersome symptom?
Anxiety
Chest pain
Palpitations
Panic attacks
Dizziness
Fatigue
Shortness of breath
2) What type of doctor do you see?
Cardiologist
Family/General practitioner
Other
None
3) Do you feel your doctor is supportive?
Very
Somewhat
Not at all
N/A
4) What is your gender?
Female
Male
5) How often do you exercise?
Regularly
Often
Sometimes
Rarely
Never
6) What type of exercise?
Aerobics/Videos
Walking
Jogging
Weight training
Some/All of the above
None
7) At what age were you diagnosed?
0-12
13-18
19-25
26-35
36-50
50Plus
8) How has MVP(S) affected your life?
Drastically
Somewhat
Not at all
9) Are you...
Overweight
Underweight
Average
10) Do you use medications to control symptoms?
Anti-anxiety
Beta blockers
Homeopathic/Natural remedies
None
11) Do you have relatives that have MVP(S)?
Parent
Sibling
Other blood relative(s)
Some/All of the above
None
12) What medication do you use to premed before dental visits?
Erythromycin
Amoxicillin
Zithromax
Clindamycin
Other
None
13) For those women who've had children: Did your major symptoms start...
Before becoming pregnant?
During pregnancy?
Within the first year of childbirth?
During/After a subsequent pregnancy?
Other
14) Do you smoke?
Yes
No
15) Do you have frequent urinary tract infections (Cystitis)?
Yes
No
16) How many amalgam (silver) fillings do you have?
None
1-3
4-6
7 or more
17) Have you been diagnosed with endometriosis?
Yes
No
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