MY APPOINTMENT DIARY
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1 MY APPOINTMENT DIARY Help in managing your heart failure
2 YOUR APPOINTMENT DIARY Use this diary in conjunction with My Marvellous Symptom Checker. How are you feeling today? 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 NYHA Class 1 NYHA Class 2 NYHA Class 3 NYHA Class 4 Symptoms No limitation of physical activity. Ordinary physical activity does not cause undue tiredness, palpitations, or shortness of breath. Referred to as NHYA 1. 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. 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. 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 points What 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. 2
3 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 3
4 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 4
5 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 5
6 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 6
7 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 7
8 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 8
9 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 9
10 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 10
11 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 11
12 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 12
13 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 13
14 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 14
15 HOW ARE YOU FEELING? (See your My Marvellous Symptom Checker or refer to page 2 of this booklet). NYHA 1 NYHA 3 NYHA 2 NYHA 4 DISCUSSION POINTS YOUR NEXT APPOINTMENT TIME: AT: 15
16 MEASUREMENTS 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 WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 16
17 MEASUREMENTS DATE WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 17
18 MEASUREMENTS DATE WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 18
19 MEASUREMENTS DATE WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 19
20 MEASUREMENTS DATE WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 20
21 MEASUREMENTS DATE WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 21
22 MEASUREMENTS DATE WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 22
23 MEASUREMENTS DATE WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 23
24 MEASUREMENTS DATE WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 24
25 MEASUREMENTS DATE WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 25
26 MEASUREMENTS DATE WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 26
27 MEASUREMENTS DATE WEIGHT TRAFFIC LIGHT (See your My Marvellous Symptom Checker) NYHA (See Page 1) 27
28 MY HEART FAILURE MEDICINES 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. HEART FAILURE MEDICINES TIME DOSE ANY SIDE EFFECTS BEDTIME EVENING AFTERNOON MORNING 28
29 MY HEART FAILURE MEDICINES HEART FAILURE MEDICINES TIME DOSE ANY SIDE EFFECTS BEDTIME EVENING AFTERNOON MORNING 29
30 MY HEART FAILURE MEDICINES HEART FAILURE MEDICINES TIME DOSE ANY SIDE EFFECTS BEDTIME EVENING AFTERNOON MORNING 30
31 MY HEART FAILURE MEDICINES HEART FAILURE MEDICINES TIME DOSE ANY SIDE EFFECTS BEDTIME EVENING AFTERNOON MORNING 31
32 The heart failure charity WATCH PMTV Live HF ON YOUTUBE youtube.com/pmtvlivehf THE MARVELLOUS CHANNEL ADDRESSING THE PATIENT, CARER, DOCTOR AND NURSE CHALLENGES OF HEART FAILURE Contact Can you help us by donating or fundraising? 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 heart failure aware (open) help for hearts (closed support group) Help fund our marvellous guides Text: MARV02 2 MARV02 5 or MARV02 10 to Copyright 2017 All Rights Reserved Pumping Marvellous Foundation Registered Charity Number Review date March 2021 Version 3
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