Evaluation and Treatment of Cardiac Tamponade in a Pregnant
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Cardiac tamponade is a life-threatening emergency requiring prompt diagnosis and treatment. Patients often present acutely with chest pain, dyspnea, and tachypnea with cardiovascular collapse, but the disease course may be subacute or chronic with an initial asymptomatic period followed by progression . It can be difficult to discern whether common findings in pregnancy like peripheral edema, dyspnea, and hyperventilation are physiologic or pathologic in etiology.

Here is a case of a 29-year-old at 32 weeks of gestation presented with a 3-day history of worsening chest pain, dyspnea, orthopnea, and shoulder pain. She was previously in good health without comorbid medical issues. Initial work-up at the outside hospital included a computed tomography (CT), which was significant for a large pericardial effusion with no evidence of pulmonary embolism.

On arrival, the patient was uncomfortable and leaning forward, with a blood pressure of 127/80 mmHg, pulse of 124 beats per minute, respirations of 24 times per minute, and an oxygen saturation of 97%. She appeared in distress. There was tachycardia and distant heart sounds on physical examination.

A transthoracic echocardiogram showed a large pericardial effusion with tamponade physiology and a left ventricular ejection fraction of 50% . The patient had worsening chest pain and discomfort. The obstetric team performed fetal monitoring which demonstrated no abnormalities.
It was decided that surgical pericardial window and drainage with drain placement was the most appropriate treatment because the majority of the pericardial effusion was posterior and would not be amenable to percutaneous drainage. The patient received a dose of betamethasone for fetal benefit, and underwent an uncomplicated pericardial window and drainage under general anesthesia with standard monitoring and continuous fetal monitoring. A total of 400 mL of serous fluid was drained from the pericardial space. Her vital signs normalized and symptoms resolved postoperatively. The pericardial drain was removed on the day of discharge, postoperative day 7.

Serum antibody titers were positive for Coxsackie B virus infection. The patient had an uneventful postoperative course following pericardial window and drainage and returned at 38 weeks for scheduled repeat cesarean delivery and bilateral tubal ligation. A repeat echocardiogram prior to surgery revealed no reaccumulation of pericardial fluid. The cesarean was uncomplicated, and she gave birth to a live male infant weighing 3420 grams. She was discharged home on postoperative day 3. Her postpartum course was uncomplicated.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985926/
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