Heart Failure Zones: Your Action Plan

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:

• Weigh yourself daily. Write down the number in a log.

• Check your body for swelling.

• Take note of how you feel each day when breathing.

Your healthcare provider: _________________________________

Their phone number: ___________________________________

Your target weight: _________

If you feel this way:

Have no trouble breathing

Have no chest pressure or pain

Have a stable weight

Have no change in swelling of feet, ankles, legs, belly

You feel OK when active

Do this:

Keep managing your heart health well.

If you have these symptoms:

Trouble breathing when at rest

Hard to breathe when lying down

Need to sleep in a chair or with extra pillows

Hard to breathe when active

Feeling very tired

Trouble doing daily activities

Persistent cough

Whistling sounds when you breathe (wheezing)

Weight gain of 2 to 3 pounds or more in 1 day

Weight gain or loss of 5 pounds in 1 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:

Hard to breathe at rest

More trouble sleeping or can't lie flat

Loss of appetite

Frequent, persistent cough

Increased discomfort or swelling in the lower body

Fast or irregular heartbeat

Chest pressure or pain

New or worse confusion, dizziness, sadness, or depression

Can’t stay alert or awake

Fainting or passing out

Do this:

Call 911 or go to the emergency room now. You need care right away.