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Refractory Heart Failure

Robert H. Seller, MD; Osvaldo Ramirez, MD; Albert N. Brest, MD; John H. Moyer, MD
JAMA. 1965;193(2):147-148. doi:10.1001/jama.1965.03090020061014.
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Patients with cardiac decompensation who fail to respond satisfactorily to routine therapeutic measures are generally categorized as having refractory heart failure. Among the multiple pathophysiologic mechanisms involved are disturbed myocardial function, diminished cardiac output, decreased renal hemodynamic functions, and aldosteronism.1

From a diagnostic standpoint, it should be remembered that obesity, phlebitis, anemia, and hypoproteinemia, as well as renal, pulmonary, and hepatic diseases, may closely resemble the cardinal signs and symptoms of cardiac failure. Therapeutically, it is noteworthy that patients with refractory heart failure not infrequently have associated conditions which, when corrected, result in improved cardiac status.2

Remediable Extracardiac Conditions  Remediable extracardiac conditions may include inadequate restriction of physical activity or salt intake, or both. Inadequate dosage of digitalis can also contribute to refractory heart failure. Although toxic reactions to digitalis are prone to develop in patients with severe cardiac decompensation, it may nonetheless be helpful to increase digitalis

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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