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Volume 6, Issue 4 (2025)
J Clinic Care Skill 2025, 6(4): 1001-1008 |
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Received: 2025/10/11 | Accepted: 2025/10/25 | Published: 2025/10/18
Received: 2025/10/11 | Accepted: 2025/10/25 | Published: 2025/10/18
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Alizadeh Z, Zade Bagheri F, Jokar S. Persistent Hypotension with Relative Bradycardia After Surgery: An Unusual Case of Preventable Hypothermic Shock. J Clinic Care Skill 2025; 6 (4) :1001-1008
URL: http://jccs.yums.ac.ir/article-1-444-en.html
URL: http://jccs.yums.ac.ir/article-1-444-en.html
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Abstract (135 Views)
Background:Postoperative hypotension is a common and potentially life-threatening complication, typically accompanied by compensatory tachycardia. The occurrence of persistent hypotension with relative bradycardia is unusual and suggests distinct mechanisms such as conduction abnormalities, medication effects, electrolyte disturbances, or hypothermia. Prompt recognition of the underlying cause is essential to avoid adverse outcomes.
Case Presentation:We describe a 54-year-old woman who developed persistent hypotension [70/40 mmHg] with relative bradycardia [55 bpm] following total abdominal hysterectomy under general anesthesia. Laboratory workup, electrocardiography, and echocardiography were unremarkable. Despite administration of 2 liters of intravenous fluids, no improvement was observed. Her core temperature was 35.3°C. On reassessment, a wet surgical drape was found underneath her back, causing hypothermia. Removal of the drape and active rewarming restored hemodynamic stability [BP 110/70 mmHg, HR 75 bpm, Temp 36.3°C], which was maintained throughout hospitalization.Discussion:Hypothermia can impair cardiovascular stability through bradycardia, reduced myocardial contractility, vasodilation, and diminished catecholamine responsiveness. In this case, inadvertent perioperative hypothermia due to a wet drape was the sole cause of refractory hypotension with relative bradycardia. This highlights the importance of including environmental and physical factors in the differential diagnosis when standard investigations are unrevealing.
Conclusion:Persistent hypotension with relative bradycardia in the postoperative setting should raise suspicion for hypothermia after exclusion of common causes. Preventable perioperative factors, such as retained wet drapes, must be systematically addressed to improve patient safety.
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