[Myocardial dysfunction in septic shock]

Septic shock is known to induce progressive myocardial dysfunction characterized hemodynamically by a decrease in cardiac output and a rise in ventricular filling pressures. Both ventricles are affected. Benefit from inotropic agents is inconsistent. Identification of the factors responsible for the progressive cardiac deterioration is rendered difficult by the complexity of clinical situations. Experimental models demonstrate a progressive inhibition of contractility. Several arguments suggest the possible role of interstitial myocardial edema in altering the microcirculation, decreasing substrate delivery and diminishing ventricular compliance. The role of a myocardial depressant factor has still to be demonstrated.