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Heart Valve Disease Monitoring Chart

Track Your Heart Valve Health Progress

Cardiology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date of Diagnosis: //___ Treating Physician: _________________

Symptoms Tracking

Rate severity (0-10, 0=none, 10=severe)

Daily Monitoring

  • Shortness of breath: ___
  • Fatigue level: ___
  • Chest discomfort: ___
  • Swelling in ankles/feet: ___
  • Heart palpitations: ___

Vital Signs

Blood Pressure

Date Morning Evening

Heart Rate

Date Resting Rate After Activity

Medication Log

Medication Dosage Time Taken Notes

Exercise Tolerance

  • Distance walked: ______ minutes
  • Activities completed:
    • Light housework
    • Climbing stairs
    • Walking outdoors
    • Other: _________

Follow-up Appointments

Date Provider Notes

Warning Signs (Check if experienced)

  • Sudden weight gain (>2 lbs in 24 hours)
  • Severe shortness of breath
  • Chest pain at rest
  • Fainting episodes
  • Irregular heartbeat

Contact your healthcare provider immediately if you experience any warning signs

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