Differential Diagnosis for a 32yo Female 1 Week Postpartum from C-Section with PE, Bradycardia, and Hypertension

• Single Most Likely Diagnosis
  • Pulmonary Embolism (PE) with associated hypertension and bradycardia: This is the most likely diagnosis given the presentation of PE, which is a known risk postpartum, especially after a C-section. The bradycardia could be a response to the pain or a sign of a more severe condition, and hypertension could be related to the stress of the event or pre-existing conditions.
• Other Likely Diagnoses
  • Postpartum preeclampsia: Although less common postpartum, preeclampsia can occur after delivery, especially if there were pre-existing hypertension issues. The symptoms of hypertension and potential for pulmonary edema could mimic or complicate a PE.
  • Postpartum hemorrhage (PPH) leading to hypovolemic shock, which could cause bradycardia and hypertension as compensatory mechanisms: Although the primary symptom here is PE, PPH is a significant postpartum risk that could lead to these symptoms if there's significant blood loss.
  • Amniotic fluid embolism (AFE): A rare but serious condition that could present with sudden onset of hypotension, hypoxia, and either bradycardia or tachycardia. The presence of PE might overshadow the initial diagnosis, but AFE is a critical consideration.
• Do Not Miss Diagnoses
  • Cardiac causes such as myocardial infarction or peripartum cardiomyopathy: These conditions could present with similar symptoms, including PE, bradycardia, and hypertension, and are critical to diagnose early due to their high mortality rates if untreated.
  • Sepsis: Postpartum sepsis, especially after a C-section, could lead to a systemic inflammatory response syndrome (SIRS) that might include hypertension, bradycardia, and could complicate or mimic a PE.
  • Anesthetic complications from the C-section: Although less likely a week postpartum, certain anesthetic complications could lead to prolonged effects, including respiratory issues that might present similarly.
• Rare Diagnoses
  • Thrombotic thrombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS): These are rare conditions that could present with thrombocytopenia, microangiopathic hemolytic anemia, renal failure, and neurological symptoms, and might be considered if there are additional symptoms beyond PE, bradycardia, and hypertension.
  • Air embolism: A rare but potentially fatal condition that could occur postpartum, especially after invasive procedures, presenting with sudden respiratory distress, which might be confused with PE.