A 66 year-old patient of CHF goes out of town and does not follow his low-salt diet. Five days later, he presented with severe shoness of breath with significant pulmonary edema. The first-line drug of choice is:

The initial drug of choice in hea failure is usually diuretics. Almost all cases of symptomatic hea failure are treated with a diuretic. High ceiling diuretics (furosemide, bumetanide) are the diuretics of choice for mobilizing edema fluid; later they may be continued in low doses. However, resistance may develop to even high ceiling diuretics after prolonged use in advanced hea failure. Addition of spironolactone to furosemide may overcome the resistance. Thiazide alone has very limited role in CHF.