title: Trepopnea may explain right-sided pleural effusion in patients with decompensated heart failure.
abstract: BACKGROUND
  Physicians often overlook trepopnea as a symptom, and its prevalence and clinical repercussions are not usually described. We propose that trepopnea is a common symptom in heart failure (HF) and, because of patient avoidance of left lateral decubitus position, contributes to the greater prevalence of right-sided pleural effusion in patients with HF. Accordingly, this study aimed to determine trepopnea prevalence and to evaluate the association of trepopnea and the laterality of pleural effusion in decompensated HF.
  
  
  METHODS
  Consecutive patients (n = 37) with decompensated HF and evidence of pleural effusion by chest x-ray were included. Data were collected at the emergency department by a standard clinical examination in which patients were specifically asked about the presence of trepopnea and preferred decubitus position while recumbent. Chest x-ray and echocardiographic parameters were recorded.
  
  
  RESULTS
  Of the 37 patients, 19 (51%) reported trepopnea. Most patients presented with right-sided pleural effusion; only 2 patients (5.4%) presented with left-sided pleural effusion. Patients who reported trepopnea had predominant right-sided pleural effusion more frequently than patients without this symptom (73.7% vs 26.3%; P = .049). The participants that reported trepopnea or avoidance of left lateral decubitus position while recumbent or both had a greater probability of having predominant right-sided pleural effusion (likelihood ratio, 1.85; 95% confidence interval, 1.02-3.35).
  
  
  CONCLUSIONS
  Trepopnea is a common symptom in patients with decompensated HF and is associated with predominant right-sided pleural effusion in this population. Our results indicate that trepopnea may be a contributory factor for pleural effusion laterality in patients with decompensated HF.
authors.affiliation: Heart Failure and Cardiac Transplantation Unit, Cardiology Division at Hospital de Clínicas de Porto Alegre (HCPA), Federal University of Rio Grande do Sul (UFRGS) Medical School, Porto Alegre, Brazil.
authors.forename: Bruno Schneider
authors.initials: BS
authors.lastname: de Araujo
authors.forename: Roberta
authors.initials: R
authors.lastname: Reichert
authors.forename: Diego André
authors.initials: DA
authors.lastname: Eifer
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Soder
authors.forename: Manoel B Schmiedel
authors.initials: MB
authors.lastname: Dos Santos
authors.forename: Nadine
authors.initials: N
authors.lastname: Clausell
authors.forename: Luís
authors.initials: L
authors.lastname: Beck-da-Silva
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000150:complications* / Q000209:etiology; D004452:Echocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D011187:Posture; D018709:Statistics, Nonparametric