Symptom:
Vital Sign: PR: ……………… BP: ……………… Angina Functional Class Syncope Dyspnea PND Dizziness Weakness Other: ……………………………………….…………………… |
Present Clinical Situation:
Symptom Free Previous MI Previous CAGB Previous PTCA Stable Angina Unstable Angina STEMI NSTEMI HF Class: ……………… Class: ……………… Date: …..........…... Date: ……….…... |