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CC BY-NC-ND 4.0 · AJP Rep 2023; 13(04): e94-e97
DOI: 10.1055/a-2200-3497
Case Report

A Rare Case of Obstructive Shock due to Cardiac Tamponade in a Term Pregnancy

Megan Masten
1   Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
,
Haya Kaliounji
2   School of Medicine, University of Colorado, Aurora, Colorado
,
Josephine Chou
3   Department of Medicine, Division of Cardiology, University of Colorado, Aurora, Colorado
,
Alexis Tumolo
3   Department of Medicine, Division of Cardiology, University of Colorado, Aurora, Colorado
,
Jonathan S. Hirshberg
4   Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado
,
Lauren Sayres 
5   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado, Aurora, Colorado
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Abstract

Obstructive shock due to cardiac tamponade is a rare, life-threatening occurrence in the peripartum period. Etiologies include preeclampsia, infection, autoimmune conditions, and malignancy. Early recognition of the underlying disease process allows for multidisciplinary treatment and a favorable outcome.

A 33-year-old presented for cardiac tamponade identified in the peripartum period. She was diagnosed with preeclampsia with severe features immediately prior to her repeat cesarean delivery and received magnesium prophylaxis. Postoperatively, she developed hypotension, tachycardia, and shortness of breath and was found to have a pericardial effusion with tamponade physiology. She underwent pericardial drain placement which was initially successful. However, she had recurrent symptomatic tamponade and thus a pericardial window was performed resulting in improvement of her symptoms. Workup revealed pericardial inflammation possibly secondary to a viral source, and she was successfully treated with anti-inflammatory therapy.

We hypothesize that this patient's cardiac tamponade was caused by inflammatory pericarditis exacerbated by severe preeclampsia. Preeclampsia is a disease characterized by cardiovascular remodeling and fluid shifts in other compartments and thus is theorized to have contributed to this patient's effusion. Cardiac tamponade should be considered in the differential for any parturient presenting with hypotension and shortness of breath.

Keywords

cardiac tamponade - pericardial effusion - pericarditis - obstructive shock - preeclampsia


Publication History

Received: 02 March 2023

Accepted: 19 October 2023

Accepted Manuscript online:
27 October 2023

Article published online:
12 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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