Age

Gender (     ) Male (     ) Female

White (     ) Yes (     ) No

Black (     ) Yes (     ) No

NIH Stroke Scale on admission

Previous Stroke or Transient Ischemic Attack (     ) Yes (     ) No

Height (cm)

Weight (kg)

Systolic Blood Pressure (mmHg)

Diastolic Blood Pressure (mmHg)

Raised BMI (BMI>30kg/m²) (     ) Yes (     ) No

Waist circumference (cm)

Heart rate (beats per minute)

Cholesterol LDL-C (mg/dL)

History of Coronary Disease (     ) Yes (     ) No

History of chronic obstructive pulmonary disease (COPD) (     ) Yes (     ) No

History of Arterial Hypertension (     ) Yes (     ) No

History of Heart Failure (     ) Yes (     ) No

Known Hyperthyroidism (     ) Yes (     ) No

Smoking (     ) Yes (     ) No

History of Diabetes (     ) Yes (     ) No

Sleep apnea (     ) Yes (     ) No

Alcohol consumption
(     ) 0 (     ) 0-7 std. drinks per week (     ) 7-14 std. drinks per week (     ) 15+ std. drinks per week (     ) no consumption

Peripheral Vascular Disease (     ) Yes (     ) No

End-stage renal disease (     ) Yes (     ) No

Left Atrium Size mm

Presence of septal aneurysm (     ) Yes (     ) No

Valve Disease (     ) Yes (     ) No

Left Ventricular Hypertrophy (     ) Yes (     ) No

PR Interval ms

Presence of Left Atrial Enlargement (     ) Yes (     ) No

Atrial premature contraction/complex (     ) Yes (     ) No

Ventricular premature contraction/complex (     ) Yes (     ) No

Arrhythmia (other than Atrial Fibrillation) (     ) Yes (     ) No

Presence of symptomatic extra- or intracranial stenosis ≥50%, symptomatic arterial dissection, clinico-radiological lacunar syndrome (     ) Yes (     ) No

Significant Murmur (     ) Yes (     ) No

Presence of aortic plaque (     ) Yes (     ) No

B-type natriuretic peptide (pg/ml)