Septic cardiomyopathy or myocardial infarction?: A case report of septic shock with ST-segment elevation on ECG
Haolei Gao1, Xiaodong Wang1, Qingyue Yang2
1Department of Anesthesiology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai City, Shandong Province, China.
Insights
Trauma-induced sepsis can cause acute heart failure, potentially mimicking myocardial infarction. Early surgical intervention to remove infection sources is vital for improving outcomes in sepsis patients with cardiac complications.
Area of Science:
- Critical Care Medicine
- Cardiology
- Infectious Diseases
Background:
- Sepsis is a leading cause of mortality, with cardiac involvement potentially leading to septic cardiomyopathy.
- Uniform diagnostic criteria for sepsis-induced heart conditions are lacking.
- Limited literature exists on sepsis combined with acute myocardial infarction (AMI), especially regarding emergency surgical treatment.
Purpose of the Study:
- To present a case of trauma-induced sepsis leading to acute heart failure and suspected AMI.
- To highlight the diagnostic challenges and treatment approach for sepsis-associated cardiac events.
- To emphasize the importance of considering myocardial ischemia in sepsis-induced heart failure.
Main Methods:
- A 52-year-old patient with trauma-induced sepsis, acute heart failure, and ECG changes suggestive of AMI was treated.
- The patient underwent emergency surgery to address the infectious focus.
- Medical management included antibiotics, hemodynamic support, and rate/blood pressure control.
Main Results:
- The patient showed clinical improvement and was discharged.
- The patient remains alive and well under outpatient monitoring.
- Coronary angiography performed six months later provided further diagnostic information.
Conclusions:
- Myocardial ischemia should be considered in patients with sepsis-induced acute heart failure.
- Prompt surgical removal of infectious foci can improve prognosis.
- Distinguishing between septic cardiomyopathy and sepsis-combined AMI remains challenging, questioning current diagnostic criteria.
Rationale:
Sepsis is one of the most prevalent and deadly diseases today. Sepsis involving the heart can progress to septic cardiomyopathy; however, there is a lack of uniform diagnostic criteria. A review of the literature reveals a paucity of literature on sepsis combined with acute myocardial infarction (AMI) and no reports on emergency surgical treatment.
Patients Concerns:
A 52-year-old patient with trauma-induced sepsis leading to acute heart failure with elevated ST-segment on electrocardiogram and postoperative coronary angiography suggestive of AMI.
Diagnoses:
Small bowel rupture, infectious shock, AMI, hypertensive disease, old cerebral infarction.
Interventions:
The patient was admitted to the hospital and immediately underwent emergency surgery to remove the infected focus, with treatment with meropenem for anti-infection, ambroxol for sputum, parenteral nutritional support, sedation and analgesia, esmolol to control the ventricular rate, uradil to control blood pressure, and transfusion of red blood cells and plasma for correction of anemia and coagulation functions. Coronary angiography was performed 6 months later.
Outcomes:
The patient was discharged after showing signs of improvement and was subsequently monitored in an outpatient clinic setting. At the time of writing, the patient is still alive and well.
Lessons:
In cases of acute heart failure resulting from trauma-induced sepsis, it is crucial to consider myocardial ischemia as a potential factor. Early surgical removal of infected foci may prove beneficial in improving the patient's prognosis. However, differentiating between septic cardiomyopathy and sepsis-combined myocardial infarction can be challenging, and the appropriateness of the diagnostic criteria for sepsis at this stage is debatable.
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