Tachycardia Day Record: Track Symptoms, Triggers, Meals, Medications and Daily Assessments for Atrial Fibrillation, A-Fib, Heart Arrhythmias

Triggers and Symptoms

Triggers - pre-listed options include alcohol, stimulants, sodium levels, lack of compression, smoking, exercise, stress, and more.

Description includes options such as shooting, stabbing, aching, tingling, twitching, and more.

Affected Area - mark on the image (both front and back are available)

Symptoms include palpitations, shortness of breath, vertigo, chest pain, lightheadedness, nausea, brain fog, discolored feet, fatigue, anxiety and more.

Daily Assessments

Date and rate day overall

Circle applicable arrow to indicate 'Increased, Same, Decreased' for Pain, Stress, Fatigue, Energy, Activity, Mental Clarity, Activity Level, General Mood, Sleep Quality

Enter - Blood Pressure, Heartrate, Oxygen level and Weight

Sleep hours - both night and day

Assess as Up, Down, Normal Vertigo, Chest Pain, Vision, Breathing, Anxiety

Notes - for questions, information, insights

Activities and Medications

Activities - select from prelisted options (walking, self-care, socializing, hobbies, employment, house/yard work, childcare, commute) and enter time. Check box to indicate if you were able to exercise.

Exercise - list time spent, how you felt during the activity.

Medications - check box to indicate just your usual daily medications. There is also a checkbox for usual daily supplements. If additional medications are taken you can list them, the dose, time and whether it helped.

Meals/Snacks

Meals & Snacks - list and check applicable box to indicate if meal contained salt, dairy, gluten, sugar, fats

Completed Example

Note that both feet have been marked as discolored.

Completed Example

Daily Assessment - note that pain, stress and activity level are all marked as increased. Energy and mental clarity are decreased, while there is no change with fatigue, general mood and sleep quality.

Personal Information and Healthcare team

Introductory page has space for personal info including emergency contact, allergies, medical alerts and health conditions.

Enter name, address, phone # for physician, specialists, pharmacy as well as insurance information.

Medications and Changes

Page for current medications along with reason and refill due date.

Page for CHANGES to medications with reason for the change, new dose, and date effective.

Tests/Results and Medical Appointments

Upcoming medical appointments - with whom? for what reason, and date

Tests, date performed, and the results.

Blood Pressure Log

Includes space for heartrate and oxygen levels as well as blood pressure.

Full page

Full page