PREVALENCE OF METABOLIC SYNDROME IN

ACUTE CORONARY SYNDROME PATIENT

PATIENT DEMOGRAPHIC DETAILS

NAME:

AGE:

DOA:

MRD NO:

SEX:

DOD:

WEIGHT:

HEIGHT:

BMI:

WAIST CIRCUMFERENCE :

MEDICAL INFORMATIONS
Presenting symptoms:

Co- morbid illness:

DM

HTN

COPD

ASTHMA

LIVER CIRRHOSIS

OTHERS
(specify)

RENAL DISEASE

ARTHRITIS

Past medical history:

Past medication history:

Past surgical history:

Allergic history:

Family history:
Food habits

:
VEG:

NON- VEG:

Personal habits:
ALCOHOL

SMOKING

EXCERCISE

OTHERS

Vitals:
BP:

RR:

PR:

Lab values:
TOTAL CHOLESTROL :
HDL

LDL

VLDL

TRIGLYCERIDES

BLOOD SUGAR

Hba1c

TROPONIN 1 level

C- Reactive protein

Creatinine kinase- MB :

TEMP:

MEDICATIONS

MEDICATIONS

Dose Route Freq

Day 1

Day 2

Day 3

Day 4

Day 5

Day 1

Day 2

Day 3

Day 4

Day 5

DISCHARGE MEDICATIONS
MEDICATIONS

Dose Route Freq