What are the recommended management strategies for a patient diagnosed with a pleural effusion due to heart failure?

Recommended management strategies for a patient with pleural effusion caused by heart failure include:

• Confirm diagnosis and assess cardiac function: Use ultrasonography to exclude or confirm pleural effusion and echocardiography to assess cardiac function and guide management ¹.
• Optimize heart failure treatment: Offer low to medium dose loop diuretics (e.g., furosemide less than 80 mg daily) to control sodium and water retention, relieve breathlessness, and reduce pleural effusion ².
• Titrate diuretics according to symptoms: Adjust the dose based on symptom control and review regularly; if symptoms persist despite maximal doses, seek specialist advice ².
• Review and stop drugs that may worsen heart failure: Ensure medications that exacerbate heart failure are discontinued where appropriate ².
• Consider additional heart failure therapies: Add ACE inhibitors and beta-blockers as tolerated to improve symptoms and prognosis; if ACE inhibitors are not tolerated, use angiotensin-II receptor antagonists ².
• Manage comorbidities and precipitating factors: Optimize treatment of any underlying causes or comorbid conditions contributing to heart failure and pleural effusion ².
• Monitor renal function and fluid status: During diuretic therapy, closely monitor renal function, weight, and urine output to avoid complications ³.
• Provide follow-up and care planning: Arrange appropriate follow-up in primary care and ensure a care plan is in place including symptom monitoring and access to specialist heart failure services ²,⁴.