Metolazone As Early Add On Therapy For 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 instructions
Able to understand and grant informed consent.

Exclusion Criteria:

Inability to give informed consent.
Systolic BP < 90 mmHg
Creatinine clearance less than 20ml/min or creatinine greater than 2.5mg/dl.
Serum Sodium less than 128meq/L, potassium levels less than 3.5meq/L
Known adverse reaction to metolazone
Inability to take oral medications
Severe Aortic Stenosis (AVA < 0.8cm³)
History of Hypertrophic Obstructive Cardiomyopathy.
Metastatic Carcinoma
Severe Chronic Obstructive Pulmonary Disease (COPD), FEV < 1L
Severe dyspnea requiring prolonged CPAP or intubation
Moderate/Severe Dementia