Having heart failure means watching for symptoms each day. This sheet will help you assess your heart health daily. It tells you when you’re OK or need to get help. You will need to:
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Weigh yourself daily. Write down the number in a log.
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Check your body for swelling.
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Take note of how you feel each day when breathing.
Your healthcare provider: _________________________________
Their phone number: ___________________________________
Your target weight: _________
If you feel this way:
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Have no trouble breathing
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Have no chest pressure or pain
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Have a stable weight
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Have no change in swelling of feet, ankles, legs, belly
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You feel OK when active
Do this:
Keep managing your heart health well.
If you have these symptoms:
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Hard to breathe when lying down
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Need to sleep in a chair or with extra pillows
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Hard to breathe when active
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Feeling very tired
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Trouble doing daily activities
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Dry, hacking cough
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Weight gain of
2 to 3 pounds or more in1 day -
Weight gain or loss of
5 pounds in1 week -
New or worse swelling in feet, ankles, legs, or belly
Do this:
Call your healthcare provider now. You may need to take extra medicine or visit their office.
If you have these symptoms:
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Hard to breathe at rest
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More trouble sleeping or can't lie flat
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Loss of appetite
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Frequent, dry, hacking cough
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Increased discomfort or swelling in the lower body
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Fast or irregular heartbeat
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Chest pressure or pain
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New or worse confusion, dizziness, sadness, or depression
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Can’t stay alert or awake
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Fainting or passing out
Do this:
Call 911 or go to the emergency room now. You need care right away.
Date Last Reviewed: 09/01/2025
© 2000-2026 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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