Myocardial depression in sepsis: From pathogenesis to clinical manifestations and treatment

The cardiovascular system plays a key role in sepsis, and septic myocardial depression is a common finding associated with increased morbidity and mortality. Myocardial depression during sepsis is not clearly defined, but it can perhaps be best described as a global (systolic and diastolic) dysfunct...

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Bibliographic Details
Published in:Journal of critical care Vol. 29; no. 4; pp. 500 - 511
Main Authors: Antonucci, Elio, Fiaccadori, Enrico, Donadello, Katia, Taccone, Fabio Silvio, Franchi, Federico, Scolletta, Sabino
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.08.2014
Elsevier Limited
Subjects:
Cardiomyopathy
Catheterization, Swan-Ganz
Critical Care
Echocardiography
Hemodynamics
Humans
Hypoxia
Mitochondrial Diseases - complications
Mortality
Myocardial depression
Myocardial dysfunction
Nitric oxide
Oxidative Stress
Pathogenesis
Permeability
Pulmonary arteries
Rodents
Sepsis
Sepsis - complications
Sepsis - drug therapy
Sepsis - metabolism
Septic shock
Severe sepsis
Shock, Septic - complications
Shock, Septic - drug therapy
Shock, Septic - metabolism
Studies
Vasoconstrictor Agents - therapeutic use
Ventricular Dysfunction, Left - diagnosis
Ventricular Dysfunction, Left - etiology
Ventricular Dysfunction, Left - metabolism
Ventricular Dysfunction, Left - therapy
Ventricular Dysfunction, Right - diagnosis
Ventricular Dysfunction, Right - etiology
Ventricular Dysfunction, Right - metabolism
Ventricular Dysfunction, Right - therapy
Myocardial depression
Septic shock
Severe sepsis
Myocardial dysfunction
ISSN:0883-9441, 1557-8615, 1557-8615
Online Access:Get full text
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Summary:The cardiovascular system plays a key role in sepsis, and septic myocardial depression is a common finding associated with increased morbidity and mortality. Myocardial depression during sepsis is not clearly defined, but it can perhaps be best described as a global (systolic and diastolic) dysfunction of both the left and right sides of the heart. The pathogenesis of septic myocardial depression involves a complex mix of systemic (hemodynamic) factors and genetic, molecular, metabolic, and structural alterations. Pulmonary artery catheterization and modern echo-Doppler techniques are important diagnostic tools in this setting. There are no specific therapies for septic myocardial depression, and the cornerstone of management is control of the underlying infectious process (adequate antibiotic therapy, removal of the source) and hemodynamic stabilization (fluids, vasopressor and inotropic agents). In this review, we will summarize the pathogenesis, diagnosis, and treatment of myocardial depression in sepsis. Additional studies are needed in order to improve diagnosis and identify therapeutic targets in septic myocardial dysfunction.
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ISSN:0883-9441
1557-8615
1557-8615
DOI:10.1016/j.jcrc.2014.03.028