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Myocardial dysfunction in the patient with sepsis.
Sreenandh Krishnagopalan1, Aseem Kumar, Joseph E Parrillo
1Section of Critical Care Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
Current Opinion in Critical Care
|October 3, 2002
Summary
Septic shock rarely causes overt heart failure, but subtle myocardial depression is common. This condition, linked to cytokines and nitric oxide, is reversible in survivors.
Area of Science:
- Cardiology
- Critical Care Medicine
- Molecular Biology
Background:
- Myocardial dysfunction in sepsis has been studied for over 50 years.
- Understanding septic myocardial dysfunction is crucial for critically ill patients.
Purpose of the Study:
- To review the evolution of scientific understanding of septic myocardial dysfunction.
- To detail current knowledge on clinical and molecular aspects of this condition.
Main Methods:
- Literature review tracing scientific thought evolution.
- Analysis of clinical manifestations and molecular/cellular basis.
- Utilized radionuclide cineangiography and echocardiography.
Main Results:
- Septic shock patients exhibit a hyperdynamic state post-resuscitation.
- Overt cardiac output depression is rare; biventricular dilation and reduced ejection fraction are common.
- Myocardial depression is reversible in survivors within 7-10 days.
- Myocardial hypoperfusion is not the cause; increased perfusion and preserved high-energy phosphates observed.
- Cytokines (TNF-alpha, IL-1beta) and nitric oxide pathways implicated.
Conclusions:
- Septic myocardial depression is a distinct entity, not solely due to hypoperfusion.
- Cytokines and altered cardiac myocyte contractility mediate the dysfunction.
- Reversibility in survivors suggests potential therapeutic targets.