title: An echocardiographic assessment of cardiovascular hemodynamics in patients with large pleural effusion.
abstract: BACKGROUND
  The close relationship between pleural space and pericardial space and the dependence of their pressure kinetics are well known. This study evaluates the effects of increased intra pleural pressure due to pleural effusion on cardiovascular system.
  
  
  METHODS
  Forty patients above the age of 12 who had massive unilateral/bilateral pleural effusion due to non-cardiac etiology were included in the study. Therapeutic thoracocentesis was done for massive pleural effusion. The echocardiographic parameters measured before and after thoracocentesis were compared.
  
  
  RESULTS
  Mean age of the patients 46.6 years. Out of 40 patients 8 were females (20%). 7 patients had right atrial collapse on echo. 85% of patients had significant flow velocity changes across both tricuspid valve and mitral valve during phases of respiration.11 patients (47.82%) had IVC compressibility of <50% during inspiration. Mean flow velocity respiratory variations across tricuspid valve before thoracocentesis and after thoracocentesis E 45.04 ± 10.3,32 ± 11.3% (p value <0.001), A 53.71 ± 28%, 32.08 ± 12.5% (p < 0.001) across mitral valve E 32.30 ± 12%, 19.78 ± 7.8% (p < 0.001), A 26 ± 11.2%, 21 ± 9.3% (p 0.006) across pulmonary artery 42.63 ± 31.3%, 17.70 ± 6.2% (p < 0.001), across aorta 21.57 ± 11.4%, 14.08 ± 7.6% (p < 0.001).
  
  
  CONCLUSIONS
  Large pleural effusion has a potential to cause adverse impact on the cardiovascular hemodynamics, which could manifest as tamponade physiology. Altered cardiac hemodynamics could be an important contributor in the mechanism of dyspnea in patients with large pleural effusion.
authors.affiliation: Department of Cardiology, Madras Medical College, Chennai, India.
authors.forename: Sundar
authors.initials: S
authors.lastname: Chidambaram
authors.affiliation: Department of Cardiology, Madras Medical College, Chennai, India. Electronic address: drvenkatesans@yahoo.com.
authors.forename: Venkatesan
authors.initials: V
authors.lastname: Sangareddi
authors.affiliation: Department of Cardiology, Madras Medical College, Chennai, India.
authors.forename: Gnanavelu
authors.initials: G
authors.lastname: Ganesan
authors.affiliation: Department of Cardiology, Madras Medical College, Chennai, India.
authors.forename: V E
authors.initials: VE
authors.lastname: Dhandapani
authors.affiliation: Department of Cardiology, Madras Medical College, Chennai, India.
authors.forename: M S
authors.initials: MS
authors.lastname: Ravi
authors.affiliation: Department of Cardiology, Madras Medical College, Chennai, India.
authors.forename: K
authors.initials: K
authors.lastname: Meenakshi
authors.affiliation: Department of Cardiology, Madras Medical College, Chennai, India.
authors.forename: D
authors.initials: D
authors.lastname: Muthukumar
authors.affiliation: Department of Cardiology, Madras Medical College, Chennai, India.
authors.forename: N
authors.initials: N
authors.lastname: Swaminathan
authors.affiliation: Department of Cardiology, Madras Medical College, Chennai, India.
authors.forename: G
authors.initials: G
authors.lastname: Ravishankar
mesh_terms: D000293:Adolescent; D000328:Adult; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D002319:Cardiovascular System / Q000503:physiopathology*; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D020519:Pericardiocentesis / Q000379:methods; D010996:Pleural Effusion / Q000150:complications / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
keywords: Echocardiography; Hemodynamics; Pleural effusion; Tamponade