Subject ID
Item
Subject ID
text
C2348585 (UMLS CUI [1])
Date of birth (subject)
Item
Date of birth (subject)
date
C0421451 (UMLS CUI [1])
Examiner ID
Item
Examiner ID
text
Date of investigation
Item
Date of investigation
date
Beginning of ECG investigation
Item
Beginning of ECG investigation
time
Item
1. Has an ECG ever been performed on you before?
text
Code List
1. Has an ECG ever been performed on you before?
CL Item
I don't know (I don't know)
Item
1 a) If yes, how long ago is your last ECG investigation?
text
Code List
1 a) If yes, how long ago is your last ECG investigation?
CL Item
< 4 weeks (< 4 weeks)
CL Item
2-12 months (2-12 months)
CL Item
> 1 year (> 1 year)
CL Item
I don't know (I don't know)
Item
1 b) If yes, has your ECG always been normal?
text
Code List
1 b) If yes, has your ECG always been normal?
CL Item
I don't know (I don't know)
Item
2. Have you ever been diagnosed with a cardiac defect (currently, formerly, or during infancy)?
text
Code List
2. Have you ever been diagnosed with a cardiac defect (currently, formerly, or during infancy)?
CL Item
I don't know (I don't know)
Item
3. Are you on medication because of a cardiovascular disease?
text
Code List
3. Are you on medication because of a cardiovascular disease?
CL Item
I don't know (I don't know)
Item
4. Have you ever been diagnosed with a heart attack?
text
Code List
4. Have you ever been diagnosed with a heart attack?
CL Item
I don't know (I don't know)
Item
5. Have you been diagnosed with a cardiac valvular defect?
text
Code List
5. Have you been diagnosed with a cardiac valvular defect?
CL Item
I don't know (I don't know)
Item
6. Did you ever have a cardiac catherization?
text
Code List
6. Did you ever have a cardiac catherization?
CL Item
I don't know (I don't know)
Item
7. Have you ever been diagnosed with cardiac arrythmia?
text
Code List
7. Have you ever been diagnosed with cardiac arrythmia?
CL Item
I don't know (I don't know)
Item
8. Did you ever have heart surgery?
text
Code List
8. Did you ever have heart surgery?
CL Item
I don't know (I don't know)
Item
9. Do you have a pacemaker?
text
Code List
9. Do you have a pacemaker?
CL Item
I don't know (I don't know)
Item
10. Do you/Did you ever suffer from pulmonary disease?
text
Code List
10. Do you/Did you ever suffer from pulmonary disease?
CL Item
I don't know (I don't know)
Item
11. Do you/Did you ever suffer from a disease of the liver?
text
Code List
11. Do you/Did you ever suffer from a disease of the liver?
CL Item
I don't know (I don't know)
Item
12. Do you/Did you ever suffer from a stroke (apoplectic insult)?
text
Code List
12. Do you/Did you ever suffer from a stroke (apoplectic insult)?
CL Item
I don't know (I don't know)
Item
13. Do you/Did you ever suffer from an angiopathy (e. g. of the leg arteries, the carotid artery)?
text
Code List
13. Do you/Did you ever suffer from an angiopathy (e. g. of the leg arteries, the carotid artery)?
CL Item
I don't know (I don't know)
Item
14. Do you/Did you ever suffer from diabetes?
text
Code List
14. Do you/Did you ever suffer from diabetes?
CL Item
I don't know (I don't know)
Specifications
Item
Specifications
text
Item
Has thorax angle been used?
text
Code List
Has thorax angle been used?
CL Item
Missing (Missing)
Item
Position of ECG electrodes
text
Code List
Position of ECG electrodes
CL Item
Shifted position (Shifted position)
Item
In case of shifted position, please specify reason
integer
Code List
In case of shifted position, please specify reason
CL Item
Position on nipple (1)
CL Item
Other (see text) (2)
Other reason for shifted position
Item
If other reason for shifted electrode position applies, please specify
text
Which electrode was shifted?
Item
Which electrode was shifted?
text
Where was the electrode shifted to?
Item
Where was the electrode shifted to?
text
Item
1. 10 seconds 12 channel ECG 50 mm/sec
text
Code List
1. 10 seconds 12 channel ECG 50 mm/sec
CL Item
Saved on computer (Saved on computer)
CL Item
Both missing (Both missing)
Item
1. If ECG data (10 sec) is missing, please indicate reason
integer
Code List
1. If ECG data (10 sec) is missing, please indicate reason
CL Item
Malfunction ECG recorder (1)
CL Item
Laptop defect (2)
CL Item
Vacuum pump defect (3)
CL Item
Subject refuses ECG (4)
CL Item
Other (Specify below) (5)
Item
2. 5 minutes 12 channel ECG without metronome
text
Code List
2. 5 minutes 12 channel ECG without metronome
CL Item
Computer O.K. (Computer O.K.)
CL Item
With deficiencies (With deficiencies)
CL Item
Missing (Missing)
Item
2. If ECG (5 min) is deficient, please indicate reason
integer
Code List
2. If ECG (5 min) is deficient, please indicate reason
CL Item
Premature termination (1)
CL Item
Subject coughing/talking (2)
CL Item
Subject moving (3)
CL Item
Subject sitting up (4)
CL Item
Other (Specify below) (5)
Item
2. If ECG data (5 min) is missing, please indicate reason
integer
Code List
2. If ECG data (5 min) is missing, please indicate reason
CL Item
Malfunction ECG recorder (1)
CL Item
Laptop defect (2)
CL Item
Vacuum pump defect (3)
CL Item
Subject refuses ECG (4)
CL Item
Other (Specify below) (5)
Item
3. 20 minutes 12 channel resting ECG
text
Code List
3. 20 minutes 12 channel resting ECG
CL Item
Computer O.K. (Computer O.K.)
CL Item
With deficiencies (With deficiencies)
CL Item
Missing (Missing)
Item
3. If resting ECG is deficient, please indicate reason
integer
Code List
3. If resting ECG is deficient, please indicate reason
CL Item
Premature termination (1)
CL Item
Subject coughing/talking (2)
CL Item
Subject moving (3)
CL Item
Subject sitting up (4)
CL Item
Other (Specify below) (5)
Item
3. If resting ECG data are missing, please indicate reason
integer
Code List
3. If resting ECG data are missing, please indicate reason
CL Item
Malfunction ECG recorder (1)
CL Item
Laptop defect (2)
CL Item
Vacuum pump defect (3)
CL Item
Subject refuses ECG (4)
CL Item
Other (Specify below) (5)
Reasons for deficient ECG
Item
If other reasons apply for any deficient ECG, please specify
text
Reasons for missing ECG data
Item
If other reasons apply for any missing data, please specify
text
Item
With metronome-controlled breathing
text
Code List
With metronome-controlled breathing
CL Item
Partly/Not permanently (Partly/Not permanently)
ECG Number
Item
ECG Number
text
Beginning of incident
Item
Beginning of incident (time)
time
End of incident
Item
End of incident (time)
time
Error code
Item
Error code
integer
If necessary, give detailed description
Item
If necessary, give detailed description
text
Comments/Special incidents
Item
Comments/Special incidents
text
End of ECG investigation
Item
End of ECG investigation
time