Hemodynamics Case 5

You have a 28 year old woman who is having a Caesarean section under spinal anesthesia. Soon after the baby is delivered the mother becomes pale and states that she feels unwell. You cycle the blood pressure cuff and administer oxygen via a facemask, but she then loses consciousness, and the blood pressure reads 55/35. You administer a bolus of vasopressor and a fluid bolus.

The blood pressure cuff is not reading now and the femoral pulse is absent according to the surgeon. You order CPR to commence and administer epinephrine 1mg. The ECG shows sinus rhythm at a rate of 50/min. After 2 minutes of CPR with bag-mask ventilation a femoral pulse is present and the blood pressure cuff records a pressure of 70/40. You intubate the patient at this point and commence an infusion of phenylephrine. A TEE probe is inserted and the following image is gained.

What is the differential diagnosis?

How would proceed?