Daily Tracking Sheet for Heart Valve Disease Management
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Name: _________________
Date of Birth: _________________
Cardiologist: _________________
Emergency Contact: _________________
| Date | Time | Blood Pressure | Heart Rate | Weight | Oxygen Level |
|---|---|---|---|---|---|
Check any symptoms experienced today:
□ Shortness of breath
□ Chest pain/pressure
□ Dizziness/lightheadedness
□ Fatigue
□ Swelling in ankles/feet
□ Heart palpitations
□ Difficulty sleeping flat
Symptom severity (1-10): _____
| Medication | Dosage | Time Taken | Notes |
|---|---|---|---|
□ Minimal activity
□ Light housework
□ Short walk
□ Regular exercise
□ Other: _________________
Changes in symptoms: _________________
Questions for doctor: _________________
Emergency Contact Numbers:
Cardiologist: _________________
Emergency: 911
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