INTRACTABLE HEART FAILURE

INTRACTABLE heart failure in this discussion is defined as that failure which is apparently resistant to further treatment. An evaluation of such refractory failure should concern itself with the following questions: 1. Is the diagnosis correct? 2. Has the treatment been really adequate? 3. Has the patient been incorrectly treated and is the lack of further therapeutic response due to certain derangements resulting from this in-correct treatment? 4. If standard measures have been correctly employed, to what extent is the continuing intractability due to extracardiac factors? 5. If all possible therapy is no longer effective, what are the character-istics of the terminal stage of heart failure? These phases of the problem will be separately discussed. Patients are occasionally considered to be no longer responsive to treat-ment for heart failure when this lack of response to standard measures may