11th January 2024

A 76-year-old gentleman with a background of 3 previous myocardial infarctions presents to the emergency department with progressive shortness of breath on exertion.

A 76-year-old gentleman with a background of 3 previous myocardial infarctions presents to the emergency department with progressive shortness of breath on exertion. He is only able to manage 10 yards on the flat before having to stop due to shortness of breath. On examination, he has pitting oedema to the groin bilaterally, a grossly raised JVP to the earlobes, and bilaterally reduced air entry at the lung bases with associated bronchial breathing above these areas. A bedside pleural ultrasound confirms bilateral pleural effusions, and a diagnostic aspiration is completed. 

Investigations: 

Pleural fluid protein level 16g/L 

Pleural fluid LDH 23 units/L 

Pleural fluid M, C +S: Pending 

Given the above presentation, what is the most likely cause of the bilateral pleural effusions? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.