Metolazone As Early Add On Therapy For Acute Decompensated Heart Failure

The primary objective of the study is to determine efficacy of metolazone as synergistic therapy with Lasix in patients with acute decompensated heart failure. This will be a multicenter double blinded randomized placebo- controlled pilot study of the addition of 5 mg of metolazone per day for 2 days compared to placebo in patients admitted with acute decompensated heart failure.

Inclusion Criteria:Subject is 18 years of age at time of enrollment.Admitted with acute decompensated heart failure based on history, physical exam, and laboratory parameters, must include both:At least 1 symptom of either dyspnea, orthopnea, or edema.At least 1 sign of rales on auscultation, peripheral edema, ascites, or pulmonary vascular congestion on chest radiography.Be willing to comply with protocol-specified instructionsAble to understand and grant informed consent.Exclusion Criteria:Inability to give informed consent.Systolic BP < 90 mmHgCreatinine clearance less than 20ml/min or creatinine greater than 2.5mg/dl.Serum Sodium less than 128meq/L, potassium levels less than 3.5meq/LKnown adverse reaction to metolazoneInability to take oral medicationsSevere Aortic Stenosis (AVA < 0.8cm³)History of Hypertrophic Obstructive Cardiomyopathy.Metastatic CarcinomaSevere Chronic Obstructive Pulmonary Disease (COPD), FEV < 1LSevere dyspnea requiring prolonged CPAP or intubationModerate/Severe Dementia