Are you smoker? *

Yes No

Are you Diabetic? *

Yes No

Since when *

What is your HbA1c *

Are you on *

Do you have blood pressure? *

Yes No

What is your BP Reading? *

Do you have heart problem? *

Yes No

Do you have one or more of these symptoms *

Chest pain at rest
Chest pain on exertion
Breathlessness on exertion
Breathlessness on lying down
Swelling over feet
None of the Above

Have you undergone *

Angioplasty with stenting
Bypass surgery
Valve replacement Sx
Medical treatment only

When did you undergo the intervention/surgery? *

Are you on regular follow up with your cardiologist *

Yes No

When was your last check up?*

Do you have a pacemaker? *

Yes No

When was it last checked?*

Are you on blood thinners?*

Yes No

Which drugs?*

Aspirin
Clopidogrel
Pasugrel
Ticagrelor
Dabigatran
Acitrom
Warf
other blood thinners

What is your effort tolerance?*

What is your blood potassium level?*

Do you have *

high uncontrolled BP?
swollen feet or/and swollen body
breathlessness on lying down?
NONE OF THE ABOVE

Are you having *

Jaundice
Swollen Feet
Distended Abdomen
None of the Above

Did you suffer from any cancer?*

Yes No

Treatment status *

Do you have Anemia?*

Yes No

What is your HB %*

Do you have any congenital bleeding disorder ?*

Yes No

Which disorder?*

Did you ever have any allergy to any drugs?*

Yes No

Which drugs?*

Did you ever undergo surgery under Local Anesthesia(or)General Anesthesia ?

Yes No

Was there an ANESTHESIA related complication?*

Yes No

What was the complication?

LVPEI's Hyderabad, Bhubaneswar, Visakhapatnam and Vijayawada campuses are NABH accredited

Pre Surgical Information

Basic Details

Pre Surgical Information