Values are expressed as the mean ± SD. In comparing the pleural fluid and blood chemistries before and after the treatment of heart failure, the paired f-test was used. Correlation between the amounts of weight lost with diuresis and changes in pleural fluid chemistry were evaluated by the regression equation. Probabilities were considered significant at the 0.05 level. comments
All eight patients enrolled in the study had typical clinical and roentgenographic findings of congestive heart failure and echocardiographic evidence for ventricular dysfunction (Table 1). One additional patient was dropped after enrollment in the study, since his pleural effusion resolved prior to the second thoracocentesis. Pleural effusion was bilateral in five patients and right-sided in three.
At the time of admission, three patients were not receiving any medications, and one was receiving P-adrenergic blocker therapy only, which was stopped. The remaining four patients were receiving digoxin, furosemide, and vasodilator therapy with captopril or isosorbide dinitrate. During the period between admission and initial thoracocentesis, all patients received intravenous furosemide (20 to 40 mg). Between the two thoracocenteses, all patients received oral furosemide (40 to 160 mg) daily and intermittent doses of intravenous furosemide (20 to 40 mg). Digoxin and vasodilators were continued in the four patients who were already receiving them; in addition, one received digitalis, and three were started on vasodilator therapy. All patients responded to treatment, and before the second thoracocentesis, mean weight loss was 5.8 ± 3.2 kg. Patient 5 had unusually brisk diuresis in response to intravenous furosemide given on admission and had lost 4 kg in body weight prior to the initial thoracocentesis. At the time of the second throacocentesis, pleural effusions were smaller in all cases except patient 4, in whom the large effusion persisted, and 600 ml of fluid was removed.
Table 1—Clinical, Roentgenographic, and Echocardiographic Findings
|Case||Age,yr||EtiologyofCHF||Acute Symptoms, wk||JVP||S3||Rales||LVEF||C/TRatio|
|6||49||Ischemic and hypertension||2||+||+||+||0.34||0.63|