Archive for the ‘Heart Failure’ Category

Treatment of Congestive Heart Failure: Conclusion

Treatment of Congestive Heart Failure: ConclusionThe mechanism which causes such changes in the pleural fluid is not well understood. The blood supply to the visceral pleura is from the pulmonary artery, and its capillaries have much lower hydrostatic pressure than the capillaries of the parietal pleura, which receives its blood supply from the systemic arteries. Pleural lymphatic vessels also play an important role in the reabsorption of fluid. Pleural fluid and smaller molecules are reabsorbed by the visceral pleural capillaries, while particulate matter and protein are removed mainly by lymphatic vessels. Smaller molecules are cleared more rapidly than protein. Read the rest of this entry »

Treatment of Congestive Heart Failure: Outcome

The pleural fluid/serum LDH ratio also increased. Another patient (case 5) had a pleural fluid level of LDH and a pleural fluid/serum protein ratio in the transudative range but his fluid/serum LDH ratio was 0.64. In this patient, pulmonary embolism was excluded by ventilation-perfusion scan. With the treatment of heart failure, the pleural fluid chemistries changed, and all three criteria for exudate were met. The effusion resolved with the treatment of heart failure, and the patient is doing well after four months of follow-up. This patient had a brisk diuretic response to furosemide before thoracocentesis. We believe that the elevated pleural fluid/serum ratio is explained by this. Other investigators have reported similar instances where pleural effusions secondary to congestive heart failure met criteria for exudates. Read the rest of this entry »

Treatment of Congestive Heart Failure: Treatment of heart failure

Treatment of Congestive Heart Failure: Treatment of heart failureWe studied eight patients with typical clinical and roentgenographic findings of heart failure. We took care not to include patients in whom another etiology for pleural effusion might coexist. Patients with isolated left-sided pleural effusion were excluded, since this is an uncommon finding in heart failure. Pleural effusions responded to the treatment of heart failure. Long-term follow-up was available in all patients and did not reveal any other coexistent pleural disease. The criteria we used for selecting patients were very similar to the ones used by Light et al for the diagnosis of congestive heart failure in their study of pleural efiusions. add comment
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Treatment of Congestive Heart Failure: Discussion

The classification of pleural effusion into transudates and exudates has great clinical significance. Transudative effusions develop when there is a change in systemic factors such as an increase in capillary hydrostatic pressure or a decrease in colloid oncotic pressure. Exudates are the result of pleural inflammation, injury, or lymphatic obstruction. An exudative process always requires a more extensive and often invasive workup of the pleural space and entails a search for more life-threatening disease, especially occult malignancy. Transudative pleural effusion is a common finding in patients with congestive heart failure. It is believed that diuretic therapy may elevate the protein content of such an effusion and convert it into a “pseudoexudate ”. in detail
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Treatment of Congestive Heart Failure: Pleural fluid LDH level

Treatment of Congestive Heart Failure: Pleural fluid LDH levelIn order to evaluate the correlation between the effectiveness of diuretic therapy and changes in the pleural fluids chemistry, weight loss was used as a measure of diuresis (Table 3). There was a significant correlation between the average weight loss per day and the change in the pleural fluid protein level (r = 0.715; p<0.05); correlation with the LDH level was weak and did not reach statistical significance (r = 0.642; p<0.1). We did not find any significant relationship between the size of the pleural effusion and changes in pleural fluid chemistry. More info
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Treatment of Congestive Heart Failure: Results

Long-term follow-up (mean, 7.4 months; range, 3 to 12 months) was available in all patients. Three patients (cases 5, 6, and 8) were doing well, with no exacerbation of congestive heart failure and no recurrence of pleural effusion. One patient (patient 4) was hospitalized twice during the follow-up period, for exacerbation of congestive heart failure without pleural effusion. One patient (case 3) returned to the hospital for exacerbation of heart failure and pleural effusion. Thoracocentesis revealed a transudative effusion with an LDH level of 153 units/L in the fluid, a fluid/serum ratio of LDH of 0.54, and a fluid/serum ratio of protein of 0.44. Read the rest of this entry »

Treatment of Congestive Heart Failure: Statistical Analysis

Treatment of Congestive Heart Failure: Statistical AnalysisStatistical Analysis
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
Results
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. Read the rest of this entry »

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