Lesson 1Past cardiac history, prior heart failure, coronary disease, revascularization, arrhythmias, and hospitalizationsThis part teaches how to carefully ask about past heart problems, like previous heart failure, blocked arteries, procedures to open them, irregular heartbeats, and hospital stays, to better understand diagnosis, outlook, and treatment paths.
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 shows how to thoroughly check for chest pain, heart flutters, fainting or near-fainting, fever, and coughs that bring up phlegm or stay dry, to separate heart issues from lung or infection problems and spot urgent warnings.
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 lasts, how it worsens, and recent triggers like infections, poor blood flow, or skipping medicines, to spot sudden, building, or long-term patterns.
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 ways to check ability to exercise, changes in everyday tasks, and weight gain trends, using daily habits and recent patterns to measure 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 part guides checking social life, daily function, home help, follow-up attendance, and access to transport or emergency care, to plan safe discharge, self-care, and community support needs.
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 focus on fluid and salt consumption, alcohol habits, and recent medicine changes or forgotten doses, to identify common triggers of sudden heart failure worsening and provide 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 prescribed medicines, shop-bought drugs, herbal remedies, and recent painkiller or steroid use, 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 apneaThis section helps gather other illnesses and risks like high blood pressure, sugar control, lung conditions, kidney issues, and sleep breathing 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 review specific questions on breathlessness when lying flat, sudden night shortness of breath, and night coughs, including start, frequency, and position effects, to tell heart failure from lung causes.
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 target symptoms pointing to other issues like lung clots, chest infections, collapsed lung, or brain events, with questions to separate these from main heart failure signs.
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
