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Patient Instructions

Knowing your body and the symptoms that tell you your heart failure is getting worse will help you stay healthier and out of the hospital. At home, you should watch for changes in your:

• Heart rate
• Pulse
• Blood pressure
• Weight

When you are watching out for warning signs, you can catch problems before they get too serious. Sometimes these simple checks will remind you that you forgot to take a pill, or that you have been drinking too much fluid or eating too much salt.

Be sure to write down the results of your home self-checks so that you can share them with your doctor. Your doctor’s office may have a "telemonitor," a device you can use to send your information automatically. A nurse will go over your self-check results with you in a weekly phone call.

Throughout the day, ask yourself:

• Is my energy level normal?
• Am I getting more short of breath when I am doing my everyday activities?
• Are my clothes or shoes feeling tight?
• Are my ankles or legs swelling?
• Am I coughing more often? Does my cough sound wet?
• Do I get short of breath at night?

These are signs that there is too much fluid building up in your body. You will need to learn how to limit your fluids and salt intake to prevent these things from happening.

See also:

• Heart failure - fluids and diuretics
• Low-salt diet

You will get to know what weight is right for you. Weighing yourself will help you know if there is too much fluid in your body. You might also find that your clothes and shoes are feeling tighter than normal when there is too much fluid in your body.

Weigh yourself every morning on the same scale when you get up -- before you eat and after you use the bathroom. Make sure you are wearing similar clothing each time you weigh yourself. Write down your weight every day on a chart so that you can keep track of it.

Call your doctor if your weight goes up by more than 3 pounds in a day or 5 pounds in a week. Also call your doctor if you lose a lot of weight.

Know what your normal pulse rate is. Your doctor or nurse will tell you what yours should be.

You can take your pulse in the wrist area below the base of your thumb. Use your index and third fingers of your other hand to find your pulse. Use a second hand and count the number of beats for 30 seconds. Then double that number. That is your pulse.

Your doctor may give you special equipment to check your heart rate.

Your doctor may ask you to keep track of your blood pressure at home. Make sure you get a good quality, well-fitting home device. Show it to your doctor or nurse. It will probably have a cuff with a stethoscope or a digital readout. Practice with your doctor or nurse to make sure you are taking your blood pressure correctly.

Call your doctor if:

• You are tired or weak.
• You feel short of breath when you are active or when you are at rest.
• You are wheezing and having trouble breathing.
• You have a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit.
• You have swelling in your feet, ankles, or legs.
• You have to urinate a lot, especially at night.
• You have gained or lost weight.
• You have pain and tenderness in your belly.
• You have symptoms you think might be from your medicines.
• Your pulse or heartbeat gests very slow or very fast, or it is not regular.

Hess OM and Carroll JD. Clinical assessment of heart failure. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007: chap 23.

Hunt SA; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2005 Sep 20;46(6):e1-82

Updated by: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.