Professional paper

https://doi.org/10.15836/ccar.2014.299

Myocardial function Depression in Severe Sepsis and Septic Shock

Domagoj Mosler ; Center for rehabilitation Topusko, Topusko, Croatia
Ivica Premužić Meštrović ; University Hospital Merkur, Zagreb, Croatia
Gordana Cavrić ; University Hospital Merkur, Zagreb, Croatia
Darko Počanić ; University Hospital Merkur, Zagreb, Croatia

Abstract

Myocardial function depression is the common and most important part of the cardiovascular system reaction in the immune system’s unsuitable response to an infection, known as sepsis. Along with the dysfunction of other organs it is even more common in cases of severe sepsis and
septic shock, and has a high mortality rate that can reach up to 70%. A number of factors that have been identified (genetic, molecular, cellular, metabolic, iatrogenic) contribute to the development, pathogenesis, and outcome of this disorder, but the specific cause remains unclear. Further integrative research is needed in order to analyze and clarify the hierarchy of various mechanisms that occur in complicated sepsis in the heart and in general. The most prominent form that includes reduced
contractility, ejection fraction, and dilation of the left ventricle is often called septic cardiomyopathy. Myocardial dysfunction in sepsis is, on the whole, characterized by a temporary global (systolic and diastolic) dysfunction of the left and right sides of the heart, which occurs in complicated sepsis despite a resupply of adequate amounts of fluids and vasopressors and lasts from 7 to 10 days in case of the patient’s recovery. The most important method for diagnosing myocardial dysfunction is echocardiography, which makes possible the monitoring and suitable treatment of the patient. There is a need for additional evaluation of some biochemical results, such as troponin and B-type natriuretic peptide, which already have a significant role in early diagnosis of myocardial dysfunction. There is no specific treatment for myocardial dysfunction in sepsis. Instead, it is integrated in therapeutical approach to sepsis with complications or, in other words, an antibiotic therapy with a possible surgical removal of the infected focus. Symptomatic therapy represents an early and rapid resupply of fluids with an application of vasopressors and an inotropic therapy. A treatment aimed at myocardial dysfunction and cardioprotection in complicated sepsis is the subject of intense research.

Keywords

septic cardiomyopathy; severe sepsis; septic shock; myocardial dysfunction; heart failure

Hrčak ID:

141142

URI

https://hrcak.srce.hr/141142

Publication date:

5.9.2014.

Article data in other languages: croatian

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