6th May 2024

A 72-year-old woman with a history of congestive heart failure presents with progressive dyspnoea, orthopnoea, and bilateral ankle swelling.

A 72-year-old woman with a history of congestive heart failure presents with progressive dyspnoea, orthopnoea, and bilateral ankle swelling. She reports compliance with her heart failure medications. On examination, she has jugular venous distension, bibasilar crackles on auscultation, and a positive hepatojugular reflux. Chest X-ray reveals bilateral pleural effusions. Echocardiography shows a left ventricular ejection fraction of 35%.

Investigation:

Chest X-ray: Bilateral pleural effusions.

Echocardiogram: Left ventricular ejection fraction of 35%.

Which is the most appropriate initial management for this patient’s pleural effusions?