Heart Sufficiency Questionnaire

Name, First Name:                                                                                                             

Date of Birth:                                                               Date:                                               

1. DO YOU WAKE UP AT NIGHT?
(Bedtime is assumed to be between 10 PM & 11 PM)
a) Yes, between 1:00 & 2:00 AM  = 6 points _____
b) Yes, between 3:00 & 4:00 AM = 4 points _____
c) Yes, between 5:00 & 6:00 AM = 2 points _____
d) Yes, constantly with sleeping phases in between = 8 points _____
Score _______

2. ARE YOU ABLE TO GO RIGHT BACK TO SLEEP?
a) Yes, after urinating = 0 points _____
b) No, I stay awake for a long time and read lying down = 2 points _____
c) I am restless and have to get up = 4 points _____
d) I need to walk around for a long time
(more than 15 minutes) = 6 points  _____
e) It take me hours to fall back to sleep = 8 points _____
Score _______

3. DO YOU HAVE NIGHT SWEATS?
a) Yes, I have had them for more than 6 months = 8 points _____
b) Yes, recently on a daily basis = 6 points _____
c) Every now and then = 2 points _____
d) Yes, periodically when I have a cold = 0 points _____
(During the beginning of menopause count only 1/2 points)
Score _______

4. HOW WOULD YOU DESCRIBE YOUR NIGHT SWEATS?
a) Whole body = 8 points _____
b) Face, neck and chest = 6 points _____
c) Only on neck and chest = 4 points _____
d) Only on the neck = 2 points _____
Score _______

5. DO YOU WAKE UP WITH A POUNDING HEART?
a) Yes, it pounds for many hours regardless of what I do = 8 points _____
b) Yes, my chest is vibrating or it is pounding up to my neck = 6 points _____
c) Yes, the pounding will not go away until I get up = 4 points _____
d) Yes, but I can stay lying down
and it will stop soon afterwards = 2 points  _____
Score _______

6. DO YOU WAKE WITH PRESSURE / PAIN IN YOUR CHEST?
a) Yes, the pressure lasts for hours = 8 points _____
b) Yes, the pressure will only go away after walking
around for a long time = 6 points  _____
c) Yes, the pressure goes away directly after getting up = 4 points _____
d) Yes, the pressure goes way right after sitting up = 2 points _____
Score _______

7. DO YOU WAKE UP WITH A PULLING TOWARDS YOUR LEFT ARM,
OR IN YOUR LEFT LOWER JAW, OR
DOES YOUR LEFT SHOULDER SEEM TO HURT WITHOUT GOOD REASON?
a) Yes, the pain stays for hours = 8 points _____
b) Yes, often = 6 points _____
c) Yes, after getting up it gets better = 4 points _____
d) Yes, it gets better after sitting up = 2 points  _____
Score _______

8. DO YOU AWAKE AT NIGHT APPARENTLY FOR NO REASON,
AND ARE WIDE AWAKE WITH A VERY CLEAR MIND, AND
YOU CANNOT STOP THINKING?
YOU COULD EVEN DO WORK OR WRITE POETRY?
a) Yes, regularly, I thought this was normal for me. = 8 points _____
b) Yes, I am so wide awake that I cannot go back to sleep = 6 points _____
c) Now & then, I think my thoughts are waking me up = 4 points _____
d) Occasionally, I then read or do something = 2 points _____
Score _______

9. DO YOU HAVE SHORTNESS OF BREATH?
a) Yes, during physical activity = 2 points _____
b) Yes, now and then at night = 4 points _____
c) Yes, regularly after lying down for a long time = 8 points _____
d) Only during strenuous sports = 0 points _____
Score _______

10. CAN YOU SLEEP LYING ON YOUR LEFT SIDE?
a) No, lying on my left side I experience heart trouble,
(i.e. shortness of breath or palpitations) = 8 points  _____
b) I wake as soon as I lie on my left side = 6 points _____
c) I do not like to lie on my left side = 4 points _____
d) I can lie on either sides, and may change often = 0 points _____
Score _______

11. ARE YOU COUGHING CONSTANTLY?
a) Only when I have a cold = 0 points _____
b) Yes, for a long time and I do not know why = 2 points _____
c) Yes, when lying down or after lying down = 8 points _____
d) Yes, after lying down for a long time = 6 points _____
Score _______

Sum of the points of questions 1 to 11:                           

The Results

Group 1
Every one has the odd bad or sleepless night from time to time if our daily routine is strenuous.

Group 2
You are at risk from developing heart insufficiency. I would recommend that you should have the initial assessment.

Group 3
We recommend that you take your health seriously. There is a possibility that a preliminary stage of heart insufficiency or coronary artery disease is underlying. You should seek professional help.

Group 4
It is time concern yourself with your health! It is very probably that you have a preliminary stage of heart insufficiency. Please seek professional help.

Group 5
This is the highest risk category. Assumption of a preliminary stage of heart insufficiency. An appointment with your physician is a must. I strongly recommend that you seek an urgent appointment for a heart check up.
Do not wait any longer!

For more information see Dr. Hain’s translated article here:
https://oirf.com/2005/12/06/innovations-of-a-new-gentle-and-holistic-cardiology/

A translated article for Affiliates
From THE BRIDGE Newsletter of OIRF
Published December 8, 2005

© Copyright January 2004, Dr. Peter Hain

About the author

During his 12 years as a research assistant at the University Hospital in Mainz, Dr. Peter Hain, in addition to cardiology, is very familiar with all specialist areas of internal medicine. With his knowledge of early diagnosis and treatment of heart disease, he was able to help many patients. In particular, his new discovery of the internal cardiac pressure syndrome and the associated, often overlooked cardiac output weakness was ground-breaking. He did not focus on individual diseases or organs, but on the human being as a whole. From 2012 until his death in 2018, Dr. Peter Hain has his own practice for holistic cardiology in Bad Nauheim. There he devoted himself in particular to heart diseases, which cannot yet be adequately diagnosed and treated, by using many self-developed processes.

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