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Abstract
A patient with congestive heart failure whose remediable problems do not respond to routine therapeutic measures may be said to have refractory heart failure. Such a patient usually requires a combination of a potent diuretic and one or more potentiating agents such as aminophylline, an acidifying drug, prednisone or an aldosterone-blocking agent. Combinations of five or more diuretic agents with different pharmacodynamics can be used effectively.