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The prognosis for severe heart failure in children (in the absence of a correctable congenital lesion) is poor. Recently, there have been advances in treatment in both medical and surgical fields.
Diuretics are still used to produce rapid symptom relief; however, there has recently been a trend to use a combined lower dose regimen of loop and thiazide diuretic,1 which has some therapeutic advantage, although pre-prepared combination drugs are limited in children by the high doses available. Digoxin use remains controversial, although it is now accepted to be an orally active inotrope its use in adults does not improve survival.2Angiotensin converting enzyme (ACE) inhibitors are now considered the cornerstone of heart failure treatment. In adults they have been shown to reduce mortality.3 4 There is no equivalent published data on such large series in children, but most paediatric cardiologists agree on the effectiveness of these drugs. A paediatric suspension of captopril has become available in the UK this year, a suspension of crushed tablets was used in infants before this. Careful introduction of captopril in a hospital environment is essential because of first dose hypotension and exacerbation of occult renovascular disease. β Blockers have been shown …