It's easy to forget symptoms during your appointment. Use this tracker to capture how you're feeling day-to-day. Bringing these notes to your next appointment ensures you and your cardiologist can make the best decisions for your care.
About this tool
This symptom tracker is designed to help you record and reflect on your HCM symptoms before your next cardiologist appointment. It is not a clinical tool and is not intended to diagnose, treat or monitor your condition.
Your responses are not reviewed or monitored. If you have concerns about your symptoms at any time, please contact your cardiologist or GP immediately — do not wait for your next scheduled appointment. This tool should not be used as a substitute for professional medical advice.
Your privacy matters to us
Any personal information you provide (including your email address if you choose to receive your report) will only be used to provide you with your symptom tracker report and handled in accordance with our Privacy Policy and the Privacy Act 1988 (Cth).
Section 1: Symptoms
Click on any of the symptoms that you have experienced in the past 6 months.
For each symptom, select how frequently they occur and how severe they were.
1.a Shortness of breath - How often did the following symptoms occur?
1.b Shortness of breath - How have the following symptoms limited your ability to do what you wanted or needed to do?
2.a Tiredness or fatigue - How often did the following symptoms occur?
2.b Tiredness or fatigue - How have the following symptoms limited your ability to do what you wanted or needed to do?
3.a Rapid, fluttering or strong heartbeat - How often did the following symptoms occur?
3.b Rapid, fluttering or strong heartbeat - How have the following symptoms limited your ability to do what you wanted or needed to do?
4.a Chest pain (e.g. pressure, tightness, squeezing) - How often did the following symptoms occur?
4.b Chest pain (e.g. pressure, tightness, squeezing) - How have the following symptoms limited your ability to do what you wanted or needed to do?
5.a Feeling dizzy or light-headed - How often did the following symptoms occur?
5.b Feeling dizzy or light-headed - How have the following symptoms limited your ability to do what you wanted or needed to do?
6.a Fainting or losing consciousness - How often did the following symptoms occur?
6.b Fainting or losing consciousness - How have the following symptoms limited your ability to do what you wanted or needed to do?
7.a Swelling of the feet or ankles - How often did the following symptoms occur?
7.b Swelling of the feet or ankles - How have the following symptoms limited your ability to do what you wanted or needed to do?
Section 2: Emotional Wellbeing
1. Do you feel your HCM symptoms have affected your emotional state?
2. Have you felt that your HCM has caused a change in your mood or energy levels?
3. Do you feel you have adequate support from family, friends or healthcare professionals?
Section 3: Physical Limitations
Select the option that best describes how your symptoms have impacted everyday activities.
1. Performing your job
2. Standing I am able to stand for ______ minutes before I have to sit.
3. Climbing stairs I am able to climb ______ flights of stairs without pausing to rest or catching my breath.
4. Household tasks Do you often rely on outside help or loved ones for household tasks such as cooking, cleaning, washing, gardening or home maintenance?
5. Grocery shopping and errands Do you often rely on delivery services or loved ones for grocery shopping and errands?
6. Sleeping
7. Taking care of or keeping up with kids/grandkids (if applicable)
8. Hobbies, recreational activities
9. Keeping up with friends and family
10. Light walking (e.g. going on a stroll or walking a pet)
11. Rigorous walking for exercise
12. Walking uphill
13. Low impact exercise (e.g. yoga or pilates)
14. High intensity exercise (e.g. jogging or group fitness)
15. Playing a sport
Symptom Tracker Report
All done! You have now captured an accurate picture of your symptoms and how they affect you at this point in time. Please share this report with your cardiologist at your next appointment. For your convenience, you can access your report in any of the following ways:
OR
Schedule a reminder
before your next appointment
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Bristol-Myers Squibb Australia Pty Ltd, ABN 33 004 333 322. Melbourne, VIC, Australia. CV-AU-2600078. October 2026.