Lesson 1Past cardiac history, prior heart failure, coronary disease, revascularisation, arrhythmias, and hospitalisationsThis section covers how to gather a detailed past cardiac history, covering previous heart failure, coronary artery disease, revascularisation procedures, arrhythmias, and hospital admissions, to sharpen differential diagnosis, prognosis, 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 methodically check for chest pain, palpitations, syncope, presyncope, and respiratory or infection symptoms, aiding in separating cardiac from non-cardiac causes and spotting urgent red flags.
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 the onset, duration, and worsening of breathlessness, plus recent triggers, to differentiate acute, subacute, and chronic types and pinpoint causes like infection, ischaemia, or non-compliance.
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 discuss evaluating exercise capacity, changes in daily activities, and weight gain trends, using functional history and recent patterns to assess congestion, therapy response, and need for diuretic adjustments or other treatments.
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 section helps assess social and functional status, home support, follow-up ability, and access to transport or emergency services, guiding safe discharge, self-care, and community resource 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 dosesHere we examine fluid and salt intake, alcohol consumption, and recent medication changes or missed doses, identifying common triggers for acute decompensated heart failure and providing targeted patient 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 section deals with medication adherence, over-the-counter drugs, alternative therapies, and recent NSAID or steroid use, pointing out agents that aggravate fluid retention, blood pressure, or kidney function in heart failure.
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 apnoeaThis section involves eliciting comorbidities and risk factors like hypertension, diabetes, chronic lung conditions, kidney disease, and sleep apnoea, focusing on control levels and interactions affecting acute dyspnoea 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 9Orthopnoea, paroxysmal nocturnal dyspnoea, and nocturnal cough detailsWe review focused questions on orthopnoea, paroxysmal nocturnal dyspnoea, and night cough, including onset, frequency, and position triggers, to distinguish heart failure from lung or airway causes of night symptoms.
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, haemoptysis, fever, pleuritic chest pain, or neurologic signsWe target symptoms indicating other diagnoses like pulmonary embolism, pneumonia, pneumothorax, or neurological issues, teaching specific questions to differentiate from primary heart failure.
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
