Cardiac tamponade in a woman with preeclampsia

Preeclampsia is associated with alterations in maternal vascular permeability and can thus cause intravascular volume depletion and pathologic extravascular fluid accumulation. Although typically manifesting as peripheral edema or, in more severe cases, non-cardiogenic pulmonary edema, preeclampsia-associated vascular abnormalities can theoretically cause abnormal fluid collection in any extravascular space, including the pericardium. We report the case of a 30-year-old gravida 1 female admitted at 31 weeks 4 days’ gestation with mild preeclampsia, tachycardia, and dyspnea, whose initial workup was only significant for a small pericardial effusion. Over the course of the next 4 weeks, however, the effusion evolved into early cardiac tamponade that required expeditious pericardiotomy and cesarean delivery. The effusion virtually resolved over the first month postpartum. The case describes a unique presentation of preeclampsia and suggests that echocardiography to evaluate for pericardial effusion be considered in cases of otherwise-unexplained cardiopulmonary symptoms in the setting of preeclampsia. If detected, cardiac tamponade should be managed in association with a multidisciplinary team familiar with the physiology of cardiac tamponade.