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Published on: June 15, 2019
Sepsis-induced myocardial dysfunction: pathophysiology and management
Yasuyuki Kakihana1, Takashi Ito2, Mayumi Nakahara3
1Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan.
Abstract:
Sepsis is aggravated by an inappropriate immune response to invading microorganisms, which occasionally leads to multiple organ failure. Several lines of evidence suggest that the ventricular myocardium is depressed during sepsis with features of diastolic dysfunction. Potential candidates responsible for septic cardiomyopathy include pathogen-associated molecular patterns (PAMPs), cytokines, and nitric oxide. Extracellular histones and high-mobility group box 1 that function as endogenous damage-associated molecular patterns (DAMPs) also contribute to the myocardial dysfunction associated with sepsis. If untreated, persistent shock causes cellular injury and the liberation of further DAMPs. Like PAMPs, DAMPs have the potential to activate inflammation, creating a vicious circle. Early infection control with adequate antibiotic care is important during septic shock to decrease PAMPs arising from invasive microorganisms. Early aggressive fluid resuscitation as well as the administration of vasopressors and inotropes is also important to reduce DAMPs generated by damaged cells although excessive volume loading, and prolonged administration of catecholamines might be harmful. This review delineates some features of septic myocardial dysfunction, assesses its most common underlying mechanisms, and briefly outlines current therapeutic strategies and potential future approaches.
Insights
Sepsis triggers an inappropriate immune response, causing heart muscle dysfunction. Understanding pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs) is key to managing septic cardiomyopathy.
Area of Science:
- Cardiology
- Immunology
- Critical Care Medicine
Background:
- Sepsis involves an inappropriate immune response to pathogens, potentially leading to multiple organ failure.
- Septic cardiomyopathy, characterized by diastolic dysfunction, is a recognized complication of sepsis.
- Both pathogen-associated molecular patterns (PAMPs) and endogenous damage-associated molecular patterns (DAMPs) contribute to myocardial dysfunction in sepsis.
Purpose of the Study:
- To review the features of septic myocardial dysfunction.
- To assess the underlying mechanisms of septic cardiomyopathy.
- To outline current and potential future therapeutic strategies for septic myocardial dysfunction.
Main Methods:
- Literature review of studies on sepsis and myocardial dysfunction.
- Analysis of the roles of PAMPs and DAMPs in septic cardiomyopathy.
- Evaluation of therapeutic interventions for septic shock and its cardiac effects.
Main Results:
- Sepsis-induced myocardial dysfunction is characterized by diastolic dysfunction.
- PAMPs and DAMPs (e.g., extracellular histones, HMGB1) activate inflammatory pathways contributing to cardiac injury.
- Early infection control and appropriate fluid resuscitation are crucial, while excessive interventions may be detrimental.
Conclusions:
- Septic cardiomyopathy is a complex condition driven by immune dysregulation.
- Targeting PAMPs and DAMPs, alongside timely and judicious medical management, is essential for improving outcomes.
- Further research into novel therapeutic approaches is warranted.
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