Lesson 1Past cardiac history, prior heart failure, coronary disease, revascularisation, arrhythmias, and hospitalisationsThis section covers how to get a precise past cardiac history, including previous heart failure, coronary disease, revascularisation, arrhythmias, and hospitalisations, to sharpen differential diagnosis, prognosis, and treatment options.
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 systematically check chest pain, palpitations, syncope, presyncope, and lung or infection symptoms, to tell cardiac from non-cardiac causes and spot 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 onset, duration, and worsening of breathlessness, plus recent triggers, to spot acute, subacute, or chronic patterns and identify causes like infection, poor blood flow, 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 look at how to assess exercise tolerance, changes in daily activities, and weight gain trends, using functional history and recent patterns to check congestion, therapy response, and need for diuretic or other treatment tweaks.
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 guides checking social and functional status, home support, follow-up ability, and access to transport or emergency services, to plan safe discharge, self-care, and extra community help if needed.
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 check fluid and salt intake, alcohol use, and recent medication changes or missed doses, to pinpoint common triggers of acute worsening heart failure and guide targeted patient advice and counselling.
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 covers medication adherence, over-the-counter drugs, complementary therapies, and recent NSAID or steroid use, highlighting drugs that worsen fluid buildup, blood pressure, or kidney function in heart failure 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 apnoeaThis section covers getting details on comorbidities and risk factors like hypertension, diabetes, chronic lung disease, kidney disease, and sleep apnoea, stressing control levels and interactions affecting acute shortness of breath and heart failure 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 detailsWe check targeted questions on orthopnoea, paroxysmal nocturnal dyspnoea, and night cough, including onset, frequency, and position triggers, to separate 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 focus on symptoms pointing to other diagnoses like pulmonary embolism, pneumonia, pneumothorax, or stroke events, teaching targeted questions to differentiate from main heart failure cases.
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
