Clinicians may be reluctant to implement evidence-based guideline recommendations because they believe that patients with chronic heart failure (CHF) who are enrolled into clinical trials are not truly representative of those seen in routine practice. Moreover, there may also be perceived safety issues associated with polypharmacy in patients with CHF. Clinicians should strive to implement guideline recommendations for the management of CHF to ensure optimal patient outcome in routine clinical practice. This case report demonstrates that symptom control may require a large number of pharmacological treatments, to be administered in accordance with guidelines.