Heart failure with intractable edema, diuretic effect is not good, a considerable part of it is related to hyponatremia or hypokalemia. Hyponatremia and dilution hyponatremia can make diuretics lose diuretic effect. Water intake should be strictly restricted or sodium salt should be supplemented. In addition, chronic heart failure often leads to hypoproteinemia due to gastrointestinal congestion and poor diet. That's why diuretics don't work. After albumin infusion, diuretics can produce obvious diuretic effect. Intravenous infusion of low dose dopamine at the rate of 5 μ g/min. Kg can improve renal blood flow, and then diuretics can produce diuretic effect. Patients with hypothyroidism can take small doses of thyroid tablets orally, which is beneficial to improve appetite and eliminate edema.

It is suggested to provide blood routine, renal function, blood electrolyte, cardiac color Doppler ultrasound, chest X-ray and other results to understand the causes of oliguria. When the patient's heart function is low (less than 35%), diuretics are often ineffective, which is closely related to pump failure. Fluid replacement is often too cautious. Please analyze whether the cause of oliguria is prerenal, renal or postrenal. Then give treatment according to the cause, otherwise there is no way. Why not choose PTCA+ valve replacement for valve adhesion after second valve replacement for rheumatic heart disease?

1. To strengthen diuresis, diuretics can be used in combination, and drugs with different action mechanisms can be used intravenously to dilate renal blood vessels. Spironolactone can be added with furosemide and dopamine intravenous drip.

2. It is mentioned upstairs that it is good to pay attention to thyroid function and hypoproteinemia. I have also encountered edema in elderly people with cardiac insufficiency after long-term examination. After hypothyroidism, edema improved after adding small dose of thyroxine.

3. Pay attention to recheck electrolyte, renal function and urine routine to see if there is hyponatremia, diluted hyponatremia or hypovolemia, and the treatment is different.

4. It is still the treatment of basic heart disease. The patient underwent mitral valve replacement due to rheumatic heart disease, and the valve adhered after operation; Biphasic murmurs can be heard at the apex of the heart, so it is most important for patients to discuss whether valve replacement can be performed at the same time as heart surgery.