Heart Failure: Symptom Record

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…

Heart Failure: Symptom Record

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 ofApril 9, 2019

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

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