Table 2

Screening pro forma suitable for use in screening examinations

Name	Telephone number
Gender	Age
Personal history	Previous myocardial infarction/angina of effort/peripheral arterial disease/cerebral infarction
Family history	Angina or heart attack in:
	mother/sister aged < 65 years
	father/brother aged < 55 years
Smoking habit
Current	Cigarettes	/day
Past	Cigarettes	/day
	Length of exposure		Years
	Other tobacco

Diabetes mellitus	Yes/no
Age at menopause	Years
Body weight	kg	Height	cm
Blood pressure	Systolic	mm Hg
(treated hypertension yes/no)	Diastolic	mm Hg
Xanthelasmata	Yes/no
Other xanthomata (eg, tendon)	Yes/no
Corneal arcus in patient aged < 50 years	Yes/no

Cholesterol	mmol/l
HDL cholesterol	mmol/l
Date of last tetanus booster
Date of last cervical smear

NB If angina is diagnosed for the first time the screening nurse should refer the patient to the doctor. Referral to a cardiologist for full evaluation may be important because further investigation may be indicated on prognostic grounds even if symptoms are not severe. Of more immediate concern is lifestyle advice, control of blood pressure, blood cholesterol, and diabetes mellitus, and therapy with low dose aspirin.