Diet
What symptoms prompted you to seek medical care? When did
they begin?
Have you recently eaten more salty foods or drank more water than
usual?
Did your symptoms begin suddenly or gradually worsen over
time?
How often do you eat out?
What makes the symptoms better or worse? How often do you weigh yourself?
Do the symptoms occur continuously or only with certain activities?
Have you gained or lost weight recently?
Do symptoms improve with rest? Have you experienced any swelling? Is swelling present all day or
only evenings?
Do you have any pain now? Did you recently have pain? Rate it
on a 0-to-10 scale.
Have you felt bloated or had edema?
Has your heartbeat felt any different than usual, such as racing,
fluttering, or skipping?
How far up your legs do you have edema?
Breathing
Are your clothes, belt, rings, and shoes tighter than 1 week or 1
month ago?
Have you felt short of breath? Do you wake up short of breath at
night?
Have you had nausea or abdominal pain?
Can you speak as much as you like before getting short of breath? Medications
What makes your breathing easier? Have you taken all prescribed medications?
Do you cough? Is it worse than usual? Did you run out of any medications?
Do you cough throughout the day or mostly in the morning? Have you had diarrhea or vomiting that may have affected absorption
of medications?
Do you cough up any secretions? Have you taken extra diuretic medications?
Do you use oxygen at home? Have you changed the dose of any medication?
Sleep
Did any physician or nurse practitioner recently prescribe different
medications for you or change the dose of your medications?
Have symptoms kept you from sleeping? Do you take any over-the-counter medications or herbal supplements?
Do you sleep in bed or in a chair? Activity
Are you able to lie flat in bed? How far can you walk?
How many pillows do you use to sleep? Is this more or less than
usual?
Can you dress, bathe, prepare food, and climb stairs without stopping
to rest?
Have you recently slept more or less than usual? Do you feel
rested?
What activities could you do recently but not now because of worsened
symptoms?
Does your spouse or significant other tell you that you snore or
intermittently stop breathing during sleep?
Have you decreased your activity level?
Other
Do you have difficulty remembering information or do you have
feelings of confusion?
Have you had other health problems that may make your heart failure
worse?