Lesson 1Past cardiac history, prior heart failure, coronary disease, revascularization, arrhythmias, and hospitalizationsThis part shows how to gather detailed past heart history, covering previous heart failure, coronary issues, procedures, irregular heartbeats, and hospital stays to sharpen diagnosis, outlook, and treatment plans.
Documented heart failure diagnosisCoronary disease and prior MI detailsPCI, CABG, and other revascularizationHistory of atrial or ventricular arrhythmiasPrior cardiac and HF hospitalizationsBaseline LVEF and prior imagingLesson 2Associated symptoms: chest pain, palpitations, syncope, presyncope, fever, cough productive vs dryThis section explains how to carefully check for chest pain, heart flutters, fainting spells, near-fainting, fever, and cough types to separate heart problems from others and spot urgent warning signs.
Character and timing of chest painPalpitations pattern and triggersSyncope and presyncope red flagsFever, chills, and infection cluesCough type, sputum, and hemoptysisPleuritic versus pressure-like painLesson 3Onset, duration, and progression of breathlessness and recent precipitating eventsHere we organise questions on when breathlessness started, how long it lasted, how it worsened, and recent triggers to identify sudden, building, or long-term patterns like infections, poor blood flow, or skipped meds.
Exact onset and time course of dyspneaStable, improving, or worsening patternTriggers: exertion, rest, or recumbencyRecent infections, fevers, or travelDietary or medication nonadherenceRecent surgery, trauma, or pregnancyLesson 4Exercise tolerance, daily activity changes, and weight gain patternWe look at assessing ability to exercise, changes in daily tasks, and weight gain trends using everyday history and recent patterns to check fluid buildup, treatment response, and need for water pill changes.
Baseline versus current activity levelDyspnea with stairs or short walksRecent reduction in daily activitiesDaily weight monitoring practicesRapid weight gain and fluid retentionImpact on work and caregiving rolesLesson 5Social and functional status, support at home, ability to attend follow-up, and access to transport/emergency servicesThis guides checking social life, daily function, home help, follow-up ability, and transport to clinics or emergencies, aiding safe discharge, self-care, and linking to community support.
Living situation and caregiver supportAbility to perform basic daily tasksHealth literacy and self-management skillsReliability of transport to follow-upAccess to pharmacy and emergency careFinancial or insurance constraintsLesson 6Fluid intake, salt intake, alcohol use, and recent medication changes or missed dosesWe target fluid and salt consumption, alcohol habits, and recent med changes or misses to pinpoint common triggers of sudden heart failure worsening and offer focused advice.
Daily fluid volume and restrictionsDietary sodium sources and habitsAlcohol quantity, pattern, and bingesRecent new or stopped medicationsMissed doses of heart failure drugsPatient understanding of regimenLesson 7Medication adherence, over-the-counter drugs, complementary medicines, and recent NSAID or steroid useThis covers sticking to meds, shop-bought drugs, herbal remedies, and recent painkillers or steroids, noting those that increase fluid hold, blood pressure, or kidney strain in heart patients.
Barriers to taking prescribed medicinesUse of OTC cold and pain remediesRecent NSAID or COX-2 inhibitor useSystemic or inhaled steroid exposureHerbal and complementary productsPharmacy reconciliation and recordsLesson 8Comorbidities and risk factors: hypertension control, diabetes control, chronic lung disease, renal disease, and sleep apneaWe gather other health issues and risks like blood pressure, sugar control, lung conditions, kidney problems, and sleep pauses, stressing management and links to breathlessness severity.
Hypertension history and control levelDiabetes duration and complicationsCOPD, asthma, and lung function historyChronic kidney disease stage and trendsScreening for sleep apnea symptomsObesity, smoking, and lipid profileLesson 9Orthopnea, paroxysmal nocturnal dyspnea, and nocturnal cough detailsWe probe breathlessness lying flat, sudden night shortness, and night coughs, including start, frequency, and positions, to tell heart failure from lung or airway night issues.
Number of pillows and sleep positionTiming and frequency of PND episodesNocturnal cough pattern and triggersRelief with sitting or standing upOverlap with reflux or asthma symptomsImpact on sleep quality and fatigueLesson 10Symptoms suggesting alternative diagnoses: unilateral leg pain/swelling, hemoptysis, fever, pleuritic chest pain, or neurologic signsWe check signs of other causes like lung clots, chest infections, lung collapse, or brain events, with key questions to separate from main heart failure symptoms.
Unilateral leg pain or swelling historyPleuritic chest pain and PE suspicionFocal neurologic deficits or confusionHigh fever, rigors, and pneumonia cluesSudden onset dyspnea and pneumothoraxRed flags requiring urgent escalation
