Lesson 1Past cardiac history, prior heart failure, coronary disease, revascularization, arrhythmias, and hospitalizationsThis part shows how to get a good past heart history, covering old heart failure, coronary issues, procedures, irregular heartbeats, and hospital stays, to better figure out 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 check chest pain, heart flutters, fainting spells, near-faints, fever, and coughs (wet or dry), to tell 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 set up questions on when breathlessness started, how long it lasted, how it's worsening, and recent triggers, to spot if it's sudden, building up, or long-term, like from infection, poor blood flow, or skipping 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 checking exercise ability, changes in daily tasks, and weight gain trends, using daily life history to check for fluid buildup, med response, and if diuretics or other treatments need tweaking.
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 ability, and transport to clinics or emergencies, to plan safe discharge, self-care, and extra 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 check fluid and salt intake, alcohol, and recent med changes or misses, to identify common triggers for sudden heart failure worsening and give targeted advice and teaching.
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, pointing out what worsens fluid hold-up, blood pressure, or kidney work 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 cover asking about other illnesses and risks like high blood pressure, sugar control, lung problems, kidney issues, and sleep breathing pauses, stressing how well controlled they are and their links to breathlessness and heart failure.
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 ask specifically about breathlessness lying flat, sudden night shortness of breath, and night coughs, including start, how often, and positions, to separate heart failure from lung or throat issues at night.
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 hinting other problems like lung clots, chest infections, collapsed lung, or brain events, with questions to tell them apart 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
