FAINTING HISTORY

Print this list of questions, complete the answers and take them with you to discuss with your healthcare team.

  1. I had my first unexplained fainting spell _______ (date).
  2. I have had _____fainting spells in the past two years.
  3. Before I fainted, I was _______________________.
  4. I drive.
    • True
      False
  5. I am worried about fainting while driving.
    • True
      False
  6. My job puts me at risk for fainting.
    • True
      False
  7. I am worried about fainting at work.
    • True
      False
  8. I have been monitored or tested to find the cause of my fainting.
    • True   List tests _____________________________
      False
  9. I have heart palpitations or other heart irregularities before or after fainting.
    • True
      False
  10. My family history includes underdiagnosed fainting or sudden cardiac death.
    • True
      False
  11. I am receiving treatment for fainting spells but the treatment is not helping.
    • True   List tests _____________________________
      False

Reference

  1. Morag R, Brenner B. Syncope. Medscape. April 16, 2014. Accessed November 10, 2015. http://emedicine.medscape.com/article/811669-overview#a5