1. Has a doctor detected a weak left ventricular in your heart?
2. Do you experience a sense of hopelessness or lack of interest in activities you used to enjoy?
3. Have you been feeling more emotionally sensitive or prone to crying?
4. Are you experiencing excessive fatigue or lack of energy?
5. Have you lost your appetite or experienced changes in your eating habits?
6. Do you find it difficult to sleep or have trouble staying asleep?
7. Do you generally feel physically unwell or unfit recently?
8. Do you have low blood pressure?
9. Do you experience irregular heartbeats?
10. Has your doctor detected any fluid in your lungs?
11. Are you experiencing any chest pains?
12. Have you been seen by a doctor who has suggested you may have broken heart syndrome?
13. Have you ever had a head injury or been diagnosed with a seizure disorder?
14. Have you ever been diagnosed with anxiety or depression?
15. How old are you?
16. Have you recently won the lottery, had to speak in public, or had someone throw a surprise party for you?
17. Have you recently been through any event that changed the course of your life?
18. Have you recently experienced an extremely emotional event or trauma?
19. Are you experiencing any nausea?
20. Do you have any shortness of breath?
