Pericardial and pleural effusions in congestive heart failure-anatomical, pathophysiologic, and clinical considerations.
Transudative pleural and pericardial effusions are not uncommon in patients with congestive heart failure. Pericardial effusion forms only with elevation of the right-sided filling pressure in the heart. In patients with biventricular failure, there is no evidence that elevated left-sided pressure, in the absence of elevated right-sided pressure, can cause a pericardial effusion. Pleural effusion forms with acute elevation of the right-sided or the left-sided filling pressure in the heart. In patients with congestive heart failure, elevated right-sided filling pressures are less common than elevated left-sided filling pressures, thus, explaining a lower prevalence of pericardial than pleural effusions. Pleural effusions in patients with congestive heart failure are typically bilateral. However, a unilateral pleural effusion is more commonly seen on the right side. Although multiple theories attempt to explain the right-sided preponderance of pleural effusion, to date, no mechanism has been universally accepted or experimentally proven.
Natanzon
Alex
A
Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York 10016, USA.
Kronzon
Itzhak
I
D000818:Animals; D004195:Disease Models, Animal; D006333:Heart Failure / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D010490:Pericardial Effusion / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D010996:Pleural Effusion / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology