Paradoxical Hemodynamics in Pericardial Decompression Syndrome: Cardiogenic Shock and Recovery With Mechanical Circulatory Support.

BACKGROUND: Pericardial decompression syndrome is a rare but potentially fatal complication of pericardiocentesis or surgical drainage, causing paradoxical hemodynamic collapse despite technically successful fluid evacuation. CASE SUMMARY: A 59-year-old woman with malignant pericardial effusion underwent pericardial window surgery. Four hours later, she developed refractory shock and severe left ventricular dysfunction with a Takotsubo pattern, despite nonobstructive coronary arteries. A percutaneous left ventricular assist device provided hemodynamic support. Her left ventricular function gradually recovered. DISCUSSION: Pericardial decompression syndrome may involve hemodynamic, ischemia, and autonomic pathophysiology. Mechanical circulatory support can bridge recovery in pericardial decompression syndrome complicated by stress cardiomyopathy. TAKE-HOME MESSAGES: Pericardial fluid drainage can paradoxically lead to cardiogenic shock given multifactorial hemodynamic and neurohormonal responses; clinicians should maintain high vigilance for hemodynamic deterioration even after technically successful drainage. Mechanical circulatory support with a percutaneous left ventricular assist device can provide effective stabilization and myocardial recovery and can be lifesaving in nonischemic cardiogenic shock.