HeartCloud | For Patients & Individuals

Question 1:

Have you experienced any symptoms related to Myasthenia Gravis ("MG") in the last 24 hours?

Green circle with white checkmark aligned vertically and horizontally in middle

Yes

Question 1(a):

Please select any eye symptoms you've experienced in the past 24 hours (Select all that apply)

Droopy eyelid (ptosis)

Double vision (diplopia)

None

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Question 1(b):

Please select any symptoms you've experienced in the last 24 hours. (Select all that apply)

Slurred/soft speech

Chewing fatigue

Swallowing difficulty

Choked on food/liquid

None

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Question 1(c):

Did you experience any breathlessness in the last 24 hours

Slight	Mild	Moder.	Severe	Worst
1 2 3 4 5

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Question 1(d):

In the last 24 hours, have you had any trouble speaking in full sentences?

Yes

Question 1(e):

In the last 24 hours, have any of the following activities made you feel unusually tired or weak? (Select all that apply)

Arms above head (grooming)

Rising from chair

Walking usual distance

Neck fatigue

None

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Question 2:

In the last 24 hours, have your symptoms gotten in the way of your daily activities?

Activities were not limited.

Activities were mildly limited.

Activities were moderately limited.

Activities were severely limited.

I could not do usual activities.

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Question 2(a):

What activities did your symptoms make difficult or prevent you from doing? (Select all that apply)

Work

Red apple with green leaf stacked on 3 books (dark gray cover/binding with red bookmark icon, brown cover/binding, red cover/binding)

School

Driving

3 user icons (yellow, orange-ish red, and lilac) with yellow chat boxes above the first and third icons from left, respectively

Social Activities

Red blanket and pillow on light brown frame

Restful Sleep

Purple bottle of lotion and blue jar with cream

Self-Care (groom/eat)

Household Chores

Red heart with pointed lines and free weight

Hobbies/Exercise

No Disability

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Question 3:

In the last 24 hours, were you able to take your Mestinon (pyridostigmine) as prescribed?

Yes (All)

yellow circle with white checkmark aligned vertically and horizontally in middle

Yes (Some)

Not Applicable

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Question 3(a):

Have you taken any extra doses of your medication in the past 24 hours?

Yes

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Question 3(b):

In the last 24 hours, did you take other prescribed medications for myasthenia gravis, such as a steroid or immunosuppressant?

Yes (All)

Yes (Some)

Not Applicable

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Question 3(c):

In the last 24 hours, were you able to do your recommended therapy exercises (physical, speech, or breathing)?

Yes (All)

Yes (Some)

Not Applicable

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Question 3(d):

Have you noticed any of the following side effects in the last 24 hours? (Select all that apply)

Nausea

Diarrhea

Cramps

Dizziness

Excess saliva

Tremor/shakiness

Other

No side effects

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Question 1(b):

Question 1(c):

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