A 32-year-old woman was admitted to the operating room for emergency cesarean section. Preoperative blood pressure was 132/85 mmHg and heart rate was 188/min. Under general anesthesia, at the 25th minute of the operation, arterial blood pressure could not be measured, peripheral pulses could not be palpated, and peripheral oxygen saturation was unmeasurable. Her heart rate was 160-180/min. Peripheral circulation was collapsed and cyanosis occurred. Bolus 25 mg ephedrine was applied, and 500 mlt colloid and 1000 mlt crystalloid were given immediately. Because of hypotension, anaphylaxis was suspected, and 1 ampoule diphenhydramine and 250 mg methylprednisolone were applied together with another 25 mg ephedrine. Despite the infusion of a total of 4000 mlt crystalloid and 1000 mlt colloid, arterial pressure remained pressor-dependent. Arterial blood gas analysis was as follows: pH: 7.18, pCO2: 38, pO2: 220, lactate: 6.0, base deficit: -9, HCO3: 19 mEq/L, and central venous pressure (CVP): +25 mmHg. Hypotension remained; dopamine 15 mcg/kg/min was started. Under dopaminergic support, invasive arterial blood pressure increased to 100/70 mmHg. The patient was transferred to the intensive care unit (ICU) mechanically ventilated with dopamine infusion of 15 mcg/ kg/min. ECG showed supraventricular tachycardia (SVT), but was unremarkable for ischemia or underlying conduction abnormality. Postoperative chest X-ray showed bilateral interstitial infiltrates and enlarged cardiac silhouette. Noradrenaline infusion at 1.5 mcg/ kg/min and furosemide infusion at 10 mg/h were started. Ventilation/ perfusion scintigraphy failed to diagnose pulmonary embolism. An echocardiogram was performed and demonstrated 32% ejection fraction, systolic left ventricular dysfunction, and left atrial and ventricular dilatation. Thus, underlying peripartum cardiomyopathy was considered to be the most likely diagnosis. On the 3rd day in the ICU, the patient was weaned from the ventilator, and noradrenalin infusion was stopped. Echocardiogram performed three months later showed normalization of ejection fraction to 45%.

Keywords: Emergency, decompansation, general anesthesia, cardiomyopathy, caeserean section