Lesson 1Past cardiac history, prior heart failure, coronary disease, revascularisation, arrhythmias, and hospitalisationsLearn how to gather detailed past heart history, covering previous heart failure, coronary issues, procedures like stenting, irregular heartbeats, and past admissions to sharpen diagnosis 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 dryExplore how to ask about chest discomfort, heart flutters, fainting spells, near-faints, fevers, and cough types to separate heart problems from lung infections or other causes needing quick action.
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 eventsStructure your questions on when breathlessness started, how long it lasts, how it's worsening, and recent triggers like infections or missed medicines to spot acute from 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 patternAssess ability to walk or do daily tasks, changes in routine activities, and sudden weight increases to check for fluid build-up and guide medicine adjustments like water tablets.
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 servicesEvaluate family support, home setup, clinic visit feasibility, and access to matatus or ambulances for safe discharge plans and linking to community health resources.
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 dosesProbe drinking habits, salty foods like ugali with sukuma, chang'aa or beer use, and skipped tablets to identify common heart failure flare-up causes and teach prevention.
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, herbal remedies, and recent NSAID or steroid useCheck pill-taking routine, shop-bought painkillers, muthi or traditional herbs, and recent anti-inflammatory or steroid use that can worsen swelling 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 apnoeaUncover other illnesses like high blood pressure, sugar diabetes, lung conditions like TB scars, kidney problems, and snoring sleep issues, noting control levels affecting 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 9Orthopnoea, paroxysmal nocturnal dyspnoea, and nocturnal cough detailsAsk specifically about breathlessness lying flat, sudden night wakening gasping, and night coughs, including pillows needed, to tell heart failure from lung or throat 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, haemoptysis, fever, pleuritic chest pain, or neurologic signsSpot clues for blood clots, chest infections, collapsed lung, or stroke-like symptoms through targeted questions to rule out non-heart causes needing urgent specialist referral.
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
