Heart_nerve Questionnaire
Stress or "fraying" of the "high voltage" heart nerves (right and left bundle branch) is often asymptomatic if not accompanied by other heart muscle performance clues. Here is an early screening for nerve issues that might affect heart performance.

The fields denoted with * are compulsory fields


* Name & Surname
* Telephone
* Email
For each statement that applies to you, enter a ' X '.

1.
Fainting (syncope) on rising from stooping, squatting, or sitting?
2.
Feeling as if you're going to faint (pre-syncope)? Often light-headed?
3.
Having a slow heart rate? (Medically diagnosed bradycardia?)
4.
Heart palpitations or episodes of irregular rhythm?
5.
Shortness of breath? (Climbing stairs, walking up hill?)
6.
Under stress for a prolonged time?
7.
Angina pains? (Chest pain, tightness?)
8.
Unexplained pain or discomfort in the chest
9.
Difficulty exercising?
10.
Disruptions to normal blood flow? (Varicose veins?)
11.
Numbness, tingling in hands and/or feet?
12.
Have elevated blood pressure?
13.
Diagnosed with blood vessel calcification?