Refractory heart failure

WHEN A PATIENT WITH CONGESTIVE HEART FAILURE IS NOT RESPONDING OR DETERIORATING WITH TREATMENT, THE FOLLOWING QUESTIONS MUST BE ASKED: 1. Are the symptoms due to heart failure or an associated condition? 2. Has maximum therapy been administered? 3. What is the cause of the heart failure and is there a condition which is amenable to specific therapy? 4. Are there associated conditions which may be responsible for the poor response to treatment? 5. Is the patient a candidate for vasodilator therapy? In spite of all efforts there are some patients who will remain with intractable heart failure, but many with so called refractory failure can be improved when the above points are carefully considered.