Having heart failure means watching for symptoms each day. This sheet will help you assess your heart health daily. It tells you when you’re OK or need to get help. You will need to:
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Weigh yourself daily. Write down the number in a log.
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Check your body for swelling.
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Take note of how you feel each day when breathing.
Your healthcare provider: _________________________________
Their phone number: ___________________________________
Your target weight: _________
If you feel this way:
Have no trouble breathing
Have no chest pressure or pain
Have a stable weight
Have no change in swelling of feet, ankles, legs, belly
You feel OK when active
Do this:
Keep managing your heart health well.
If you have these symptoms:
Trouble breathing when at rest
Hard to breathe when lying down
Need to sleep in a chair or with extra pillows
Hard to breathe when active
Feeling very tired
Trouble doing daily activities
Persistent cough
Whistling sounds when you breathe (wheezing)
Weight gain of
Weight gain or loss of
New or worse swelling in feet, ankles, legs, or belly
Do this:
Call your healthcare provider now. You may need to take extra medicine or visit their office.
If you have these symptoms:
Hard to breathe at rest
More trouble sleeping or can't lie flat
Loss of appetite
Frequent, persistent cough
Increased discomfort or swelling in the lower body
Fast or irregular heartbeat
Chest pressure or pain
New or worse confusion, dizziness, sadness, or depression
Can’t stay alert or awake
Fainting or passing out
Do this:
Call 911 or go to the emergency room now. You need care right away.
