Pregnancy. Cardiogenic Shock and Congestive Heart Failure.

A 38-year-old female G2P1 at 36 weeks GA presents with acute on chronic respiratory distress in addition to chronic peripheral edema. She undergoes respiratory fatigue and hypoxia requiring intubation. She then becomes hypotensive which the team discovers is secondary to cardiogenic shock, requiring vasopressor infusion and consultation with Cardiology/ ICU.

Goals and Objectives

Educational Goal: To manage acute CHF and cardiogenic shock in a pregnant patient with cardiomyopathy.

CRM Objectives

1. Effectively lead a team through the uncommon presentation of cardiogenic shock in pregnancy.
2. Demonstrate closed-loop communication between team members.
3. Collaborate early with consultants in the management of a sick pregnant patient.

Medical Objectives

1. Recognize and respond to a critically ill pregnant patient with cardiogenic shock.
2. Hypothesize the differential diagnoses of dyspnea in pregnancy.
3. Facilitate safe intubation with considerations for a pregnant patient.