Influenza-Associated Myocarditis in Pregnancy Complicated by Perioperative Cardiac Arrest: A Case Report

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Inflammatory myocardial injury can precede the development of overt cardiomyopathy, where reduction in ejection fraction is a recognized complication. This evolution is a concern when caring for obstetric patients with myocarditis. Myocardial inflammation may affect cardiac reserve and increase susceptibility to hemodynamic collapse under anesthetic stress, presenting a unique challenge. Among neuraxial options, epidural anesthesia presents the ability to slowly titrate surgical blockade with less risk of sudden drop of systemic vascular resistance and hemodynamic collapse. However, evidence guiding intraoperative management in this population is limited, and maternal cardiac arrest in this setting remains rare. These uncertainties underscore the need to better understand anesthetic decision-making in this population, particularly when urgent delivery limits ideal neuraxial planning.

A 25-year-old G3P2 at 25 weeks gestation presented to the emergency department with chest pain, shortness of breath, and tachycardia. Initial workup was significant for influenza A infection, elevated troponin pro-BNP, and ECG changes concerning for myocarditis. An echocardiogram demonstrated preserved ejection fraction with a small pleural effusion. Upon admission, the patient experienced a syncopal episode with emesis followed by fetal bradycardia, necessitating an emergent cesarean delivery.

Our case of emergent cesarean delivery under general anesthesia in a patient with viral myocarditis demonstrates the value of a multidisciplinary approach and careful anesthetic planning during urgent scenarios. Time permitting, epidural anesthesia and pre-neuraxial arterial line placement may offer the greatest benefit for those with symptomatic myocarditis by providing hemodynamic assessment and earlier adjustment of vasopressor strategy. Adherence to pregnancy-modified ACLS guidelines remains essential regardless of underlying pathology.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2106

This document is currently not available here.

Share

COinS