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The coronary circulation in human septic shock.

R E Cunnion, G L Schaer, M M Parker

    Circulation
    |April 1, 1986
    PubMed
    Summary
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    In human septic shock, myocardial depression is not caused by reduced coronary blood flow. Coronary flow remained adequate, suggesting other mechanisms are responsible for this cardiac dysfunction.

    Area of Science:

    • Cardiology
    • Critical Care Medicine
    • Physiology

    Background:

    • Reversible myocardial depression, characterized by ventricular dilatation and reduced ejection fraction, is a frequent complication of human septic shock.
    • Animal studies suggest myocardial ischemia due to insufficient coronary blood flow as a potential cause, but this remains unconfirmed in humans.

    Purpose of the Study:

    • To investigate the relationship between myocardial depression and coronary blood flow in human septic shock.
    • To determine if reduced coronary flow contributes to cardiac dysfunction during septic shock.

    Main Methods:

    • Seven patients with septic shock underwent measurements of coronary flow and myocardial metabolism using thermodilution coronary sinus catheters.
    • Coronary flow, myocardial lactate production, and arterial-coronary sinus oxygen differences were assessed.

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    Main Results:

    • Four of seven patients developed myocardial depression, but their coronary flow was similar to or higher than controls and patients without depression.
    • No patients exhibited net myocardial lactate production, indicating no anaerobic metabolism.
    • Oxygen extraction was diminished, suggesting disordered coronary autoregulation, similar to arteriovenous shunting in other septic organs.

    Conclusions:

    • Preserved coronary blood flow and myocardial lactate extraction in septic shock patients with myocardial depression argue against global ischemia.
    • The findings suggest that mechanisms other than reduced coronary flow are responsible for myocardial depression in human septic shock.
    • Disordered coronary autoregulation, rather than ischemia, may play a role in septic myocardial dysfunction.