Cardiovascular alterations in septic shock

Cardiovascular alterations in sepsis include a decrease in vascular tone and an impairment in myocardial contractility, and occur largely as the result of the release and action of mediators of the sepsis cascade. Many mediators are involved including cytokines, particularly tumour necrosis factor and interleukin-1, and secondary mediators such as nitric oxide and oxygen free radicals. The degree of reduced vascular tone and myocardial depression have both been related to the severity of sepsis. In this article we will review current knowledge on the factors involved in the cardiovascular alterations of sepsis, the clinical implications of these alterations, and the possibilities for future treatments.