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Heart Failure: Symptom Record

Topic Contents

Topic Overview

Use this form to describe the severity of your heart failure symptoms and whether they get worse. Also, record any new symptoms that develop. Take this form with you when you visit your doctor.

Symptoms

Describe severity of symptoms and when they started

Shortness of breath

 

Swelling in your legs or ankles

 

Sudden weight gain

 

Tiredness or weakness

 

Dizziness or feeling like you might faint

 

Not sleeping well

 

Other symptoms

 

Credits

Current as of: April 29, 2021

Author: Healthwise Staff
Medical Review: Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology
Martin J. Gabica MD - Family Medicine
Adam Husney MD - Family Medicine
George Philippides MD - Cardiology