Pleural Thickening and Heart Health: Indirect Links via Lung Function and Inflammation

Pleural thickening (fibrosis of visceral/parietal pleura) does not directly cause heart disease—but associated conditions and physiologic consequences can affect the heart.

Mechanisms of Cardiac Impact

1. Restrictive Lung Physiology: Thickened pleura limits expansion → hypoxemia → pulmonary vasoconstriction → pulmonary hypertension → right ventricular hypertrophy/failure (cor pulmonale).
2. Chronic Inflammation: Empyema, rheumatoid pleuritis, asbestos → systemic inflammatory cytokines → endothelial dysfunction → accelerated atherosclerosis.
3. Space-Occupying Effects: Tumor (mesothelioma, metastasis) or massive fibrosis → compresses pulmonary vessels, atrium, or SVC → hemodynamic compromise.
4. Pericardial Extension: Inflammation spreads → pericarditis, effusion, constriction → diastolic dysfunction.

Clinical Approach

• Identify cause (asbestos, TB, RA, post-effusion, idiopathic, malignancy).
• Assess lung function (PFTs: restrictive pattern), echo (RVSP, RV function), CT.
• Treat underlying disease; manage PH if present; monitor for malignancy.

Pleural thickening is a radiologic finding—its cardiac relevance depends entirely on etiology and severity.