[SEPTIC CARDIOMYOPATHY]

Septic cardiomyopathy is a reversible myocardial dysfunction in patients with sepsis. Depression in myocardial contractility is detected in more than 40% of patients with severe sepsis or septic shock. Sepsis-induced myocardial dysfunction (SIMD) is one of the main predictors of poor outcome in patients with sepsis. Mortality rate in patients with sepsis and SIMD is 70%-90%, while it is only 20% in patients without SIMD. SIMD is characterized by ventricular dilatation, decreased ejection fraction, less response to fluid replacement and catecholamines. It is reversible within 7-10 days. Many extracellular and intracellular mechanisms and mediators included in the regulation of the heart muscle cell contraction may contribute to septic cardiomyopathy. The underlying cause is disorder in communication between the intracellular contractile apparatus and extracellular matrix, resulting in attenuation of the myocardial contraction. Hemodynamic monitoring, ECG, transthoracic and transesophageal echocardiography, and various laboratory tests are used in the diagnostic work-up. There are several therapeutic interventions such as infection control, optimization of hemodynamic parameters, adequate volume resuscitation, inotropic drugs, transfusion of blood derivatives, and statins. However, for now, there is no efficient therapy for septic cardiomyopathy. The management of SIMD includes cardio-protective therapy, etiologic treatment of sepsis and septic shock, and supportive measures.