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March 24, 1962

Refractory Cardiac Failure-Reply

Author Affiliations

2222 Central Ave., Cleveland 15

JAMA. 1962;179(12):990. doi:10.1001/jama.1962.03050120068028

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To the Editor:—  Dr. Pastor and I have different interpretations of the gist of Dr. Lyons' question (JAMA178:691 [Nov. 11] 1961). This I took to be the possibility of specific mercurial resistance as a sequel to prolonged thiazide diuretic therapy. Electrolyte imbalance and hypochloremic diuretic resistance are recognized complications of prolonged or intensive treatment with either mercurials or thiazides. Dr. Pastor's summary of the management of this problem is indeed informative. I think he would agree that recent advances in what is essentially palliative therapy do not correct defective cardiac mechanisms or progressive disease and must inevitably increase the fraction of patients who come to a point of no return.

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