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

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

• References

• 1 Haiat R, Halphen C. Silent pericardial effusion in late pregnancy: a new entity. Cardiovasc Intervent Radiol 1984; 7 (06) 267-269
• 2 Abduljabbar HS, Marzouki KM, Zawawi TH, Khan AS. Pericardial effusion in normal pregnant women. Acta Obstet Gynecol Scand 1991; 70 (4–5): 291-294
• 3 Enein M, Zina AA, Kassem M, el-Tabbakh G. Echocardiography of the pericardium in pregnancy. Obstet Gynecol 1987; 69 (06) 851-853
• 4 Imazio M, Brucato A, Rampello S. et al. Management of pericardial diseases during pregnancy. J Cardiovasc Med (Hagerstown) 2010; 11 (08) 557-562
• 5 Simpson WG, DePriest PD, Conover WB. Acute pericarditis complicated by cardiac tamponade during pregnancy. Am J Obstet Gynecol 1989; 160 (02) 415-416
• 6 Yousif PA, Sudhakar S, Malemud C, Blumenthal DE. Cardiac tamponade as initial presentation of systemic lupus erythematosus in third-trimester pregnancy. Am J Case Rep 2022; 23: e936273–1-e936273–6
• 7 Romagano MP, Patel K, Williams S, Apuzzio JJ. Evaluation and treatment of cardiac tamponade in a pregnant patient. Case Rep Obstet Gynecol 2020; 8703980
• 8 Aznaouridis K, Lazaros G, Tousoulis D, Toutouzas K. Neoplastic cardiac tamponade in a pregnant woman. Eur Heart J 2020; 41 (16) 1610
• 9 Matsuki R, Nakago S, Takaoka H, Oishi T, Kotsuji F. Cardiac tamponade in pregnancy during the treatment of severe pre-eclampsia: report of a case. J Obstet Gynaecol Res 2014; 40 (03) 826-828
• 10 Kinthala S, Fakoory M, Greaves T, Kandamaran L, Thomas H, Moe S. Subcapsular liver hematoma causing cardiac tamponade in HELLP syndrome. Int J Obstet Anesth 2012; 21 (03) 276-279
• 11 Azimi NA, Selter JG, Abott JD. et al. Angiosarcoma in a pregnant woman presenting with pericardial tamponade–a case report and review of the literature. Angiology 2006; 57 (02) 251-257
• 12 Ansari E, Karas BJ, Jiang L. A case of tamponade complicating pregnancy. Clin Cardiol 2005; 28 (02) 71
• 13 Shattuck B, Livingstone J. A case of cardiac tamponade due to an isolated abscess in the ascending aorta of a pregnant woman with a history of intravenous substance abuse. Forensic Sci Med Pathol 2017; 13 (02) 226-229
• 14 Allali F, Alami M, Doghmi N, Mohatane A, Benomar M, Hajjaj-Hassouni N. Scleroderma complicated with tamponade during pregnancy. Joint Bone Spine 2005; 72 (04) 341-343
• 15 Rifaie O, Samir S, Nammas W. Cardiac tamponade after mitral valvuloplasty in a pregnant woman. Acta Cardiol 2010; 65 (06) 699-701
• 16 Averbuch M, Bojko A, Levo Y. Cardiac tamponade in the early postpartum period as the presenting and predominant manifestation of systemic lupus erythematosus. J Rheumatol 1986; 13 (02) 444-445
• 17 Ketata W, Msaad S, Feki W, Gargouri I, Ayadi H, Ayoub A. [Postpartum pericardic tamponade revealing systemic lupus erythematosus]. Rev Pneumol Clin 2009; 65 (05) 306-308
• 18 Imazio M, Brucato A, Maestroni S. et al. Risk of constrictive pericarditis after acute pericarditis. Circulation 2011; 124 (11) 1270-1275
• 19 Ives CW, Sinkey R, Rajapreyar I, Tita ATN, Oparil S. Preeclampsia-pathophysiology and clinical presentations: JACC state-of-the-art review. J Am Coll Cardiol 2020; 76 (14) 1690-1702
• 20 Vaught AJ, Kovell LC, Szymanski LM. et al. Acute cardiac effects of severe pre-eclampsia. J Am Coll Cardiol 2018; 72 (01) 1-11
• 21 Birukov A, Wiesemann S, Golic M. et al. Myocardial evaluation of post-preeclamptic women by CMR: is early risk stratification possible?. JACC Cardiovasc Imaging 2020; 13 (05) 1291-1293
• 22 Yuan L, Duan Y, Cao T. Echocardiographic study of cardiac morphological and functional changes before and after parturition in pregnancy-induced hypertension. Echocardiography 2006; 23 (03) 177-182