Personal Cardiovascular Emergency Action Plan

Risk Assessment and Emergency Response Guide

Important Personal Information

• Full Name: _________________
• Date of Birth: _____________
• Emergency Contact: _________
• Phone: ___________________

Known Cardiovascular Conditions

• Primary diagnosis: _________
• Secondary conditions: ______
• Current medications: _______

Warning Signs to Monitor

Immediate Emergency (Call 911)

• Chest pain or pressure lasting more than 5 minutes
• Severe shortness of breath
• Fainting or severe dizziness
• Rapid or irregular heartbeat with symptoms

Urgent Care Needed (Contact Doctor)

• Mild chest discomfort
• New or worsening swelling in legs
• Unexplained fatigue
• Minor breathing difficulties

Emergency Action Steps

1. If Experiencing Severe Symptoms:

   • Call 911 immediately
   • Take prescribed nitroglycerin if available
   • Sit or lie down
   • Chew one adult aspirin (if not allergic)

2. While Waiting for Help:

   • Unlock door
   • Gather medication list
   • Stay calm and still

Prevention Checklist

• Daily medication tracking
• Blood pressure monitoring
• Weight monitoring
• Exercise as prescribed
• Follow dietary restrictions

Healthcare Provider Contacts

• Primary Care: ____________
• Cardiologist: ___________
• Pharmacy: ______________

Review this plan with your healthcare provider every 6 months