Current challenges in understanding, diagnosing and managing sepsis-induced cardiac dysfunction

Sepsis is a severe, life-threatening condition, which may be responsible for multiple complications, including cardiovascular events. Despite being a common complication, sepsis-induced cardiac dysfunction (SICD) is still not entirely understood. This review underlines the diagnosis challenges, discusses the prognosis and proposes a diagnosis path for patients with suspected SICD. Existing severity scoring systems are not able or designed to predict the risk of cardiac dysfunction in septic patients. Current biomarkers are not sufficient for the diagnosis of SICD, only for the exclusion of acute myocardial infarction. Troponin levels may be negative or slightly elevated in sepsis-induced cardiac dysfunction and natriuretic peptides are significantly more elevated in septic patients who develop cardiac dysfunction. Electrocardiogram changes are not always present. However, ischemic ST-T changes might be observed. Furthermore, sepsis is a risk factor for developing new-onset atrial fibrillation. Repeat echocardiography remains the crucial diagnosis method used to describe this reversible cardiac disorder. Acute cardiac dysfunction in septic patients requires a differential diagnosis between acute coronary syndrome, myocarditis, Takotsubo Syndrome and SICD. A combination of clinical, biochemical or imaging data is not yet validated for diagnosing SICD.