title: Metolazone in treatment of severe refractory congestive cardiac failure.
abstract: 17 patients with New York Heart Association (NYHA) class IV congestive cardiac failure, refractory to conventional treatment, were additionally treated with oral metolazone (1.25-10 mg daily). 12 improved sufficiently to be discharged from hospital (NYHA class II or III, mean weight loss 8.3 kg), 1 of whom died at home 4 weeks later. The other 5 patients were treated with intravenous dobutamine for 72 h; 2 responded (average weight loss 4.4 kg), and 2 responded to subsequent reintroduction of metolazone. 4 of these 5 patients died, 2 in hospital of acute myocardial infarction. Overall, 15 patients with very severe refractory cardiac failure improved sufficiently to be discharged from hospital. Treatment was associated with mild transient hypokalaemia in 7 patients, and hyponatraemia and renal impairment in 1, for whom metolazone dosage had to be reduced. Failure to respond to the introduction of metolazone may indicate an especially poor prognosis.
authors.affiliation: Department of Cardiology, Concord Hospital, New South Wales, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Kiyingi
authors.forename: M J
authors.initials: MJ
authors.lastname: Field
authors.forename: C C
authors.initials: CC
authors.lastname: Pawsey
authors.forename: J
authors.initials: J
authors.lastname: Yiannikas
authors.forename: J R
authors.initials: JR
authors.lastname: Lawrence
authors.forename: W J
authors.initials: WJ
authors.lastname: Arter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight / Q000187:drug effects; D002986:Clinical Trials as Topic; D004231:Diuresis / Q000187:drug effects; D004232:Diuretics / Q000627:therapeutic use*; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008788:Metolazone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011379:Prognosis
chemical_list: D004232:Diuretics; D004280:Dobutamine; D008788:Metolazone