MY APPOINTMENT

DIARY

Help in managing your heart failure

How are you feeling today?

YOUR APPOINTMENT DIARY

Feeling okay today - no change from last time.

I’m not sure, maybe it’s just one of those days.

I don’t feel like things are going as well as last time.

Where are you in New York?NYHA Class Symptoms

NYHA Class 1 No limitation of physical activity. Ordinary physical activity does not cause undue tiredness, palpitations, or shortness of breath. Referred to as NHYA 1.

NYHA Class 2 Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in tiredness, palpitations, or shortness of breath. Referred to as NHYA 2.

NYHA Class 3 Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes tiredness, palpitations or shortness of breath. Referred to as NHYA 3.

NYHA Class 4 Unable to carry out any physical activity without discomfort and tired and short of breath even at rest. If any physical activity is undertaken, discomfort increases. Referred to as NHYA 4.

Discussion pointsWhat do you feel are the priorities for your appointment? Write them down so you can discuss them

with your Healthcare Professional. Make sure you set your next appointment and write it in your diary.

Use this diary in conjunction with ‘My Marvellous Symptom Checker.’

2

HOW ARE YOU FEELING?DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

3

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

4

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

5

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

6

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

7

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

8

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

9

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

10

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

11

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

12

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

13

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

14

DATE:

DISCUSSION POINTS

YOUR NEXT APPOINTMENT

AT:

DATE: TIME:

HOW ARE YOU FEELING?

NYHA 1 NYHA 3

NYHA 2 NYHA 4

Red

Amber

Green

(See your ‘My Marvellous Symptom Checker’ or refer to page 2 of this booklet).

15

Keep track of your measurements here - it will help you determine if you have gained or lost any

weight rapidly and help you work out if you need to contact your Healthcare Professional about it.

DATE WEIGHTTRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

MEASUREMENTS

16

DATE WEIGHTTRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

MEASUREMENTS

17

MEASUREMENTSDATE WEIGHT

TRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

18

MEASUREMENTSDATE WEIGHT

TRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

19

MEASUREMENTSDATE WEIGHT

TRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

20

MEASUREMENTSDATE WEIGHT

TRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

21

MEASUREMENTSDATE WEIGHT

TRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

22

MEASUREMENTSDATE WEIGHT

TRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

23

MEASUREMENTSDATE WEIGHT

TRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

24

MEASUREMENTSDATE WEIGHT

TRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

25

MEASUREMENTSDATE WEIGHT

TRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

26

MEASUREMENTSDATE WEIGHT

TRAFFIC LIGHT (See your ‘My Marvellous Symptom Checker)

NYHA(See Page 1)

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

RedAmberGreen

1 32 4

27

HEART FAILURE MEDICINES TIME DOSE ANY SIDE EFFECTS

MO

RN

ING

AFT

ERN

OO

NB

EDT

IME

EVEN

ING

It is important to understand the medication you take to control your heart failure, if you are unsure

then why not ask your Doctor, Nurse or Pharmacist to explain what you are taking and why.

MY HEART FAILURE MEDICINES

28

HEART FAILURE MEDICINES TIME DOSE ANY SIDE EFFECTS

MO

RN

ING

AFT

ERN

OO

NB

EDT

IME

EVEN

ING

MY HEART FAILURE MEDICINES

29

HEART FAILURE MEDICINES TIME DOSE ANY SIDE EFFECTS

MO

RN

ING

AFT

ERN

OO

NB

EDT

IME

EVEN

ING

MY HEART FAILURE MEDICINES

30

HEART FAILURE MEDICINES TIME DOSE ANY SIDE EFFECTS

MO

RN

ING

AFT

ERN

OO

NB

EDT

IME

EVEN

ING

MY HEART FAILURE MEDICINES

31

Contact01772 796542

www.pumpingmarvellous.org

hearts@pumpingmarvellous.org

@pumpinghearts

heart failure aware (open)

help for hearts (closed support group)

The heart failure charity

Review date March 2021 Version 3

Help fund our marvellous guides

Text: ‘MARV02 £2’ ‘MARV02 £5’ or‘MARV02 £10’ to 70070

Copyright © 2017 · All Rights Reserved · Pumping Marvellous Foundation · Registered Charity Number 1151848

This resource has been supplied free of charge by The Pumping Marvellous Foundation. We rely on contributions

to help us provide this vital service.

Thank you!

Can you help us by donating or fundraising?

WATCH PMTV Live HFON YOUTUBE youtube.com/PMTVLiveHF

THE MARVELLOUS CHANNEL ADDRESSING THE PATIENT, CARER, DOCTOR AND NURSE CHALLENGES OF HEART FAILURE