Septic Cardiomyopathy: From Basics to Management Choices |
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| Authors: | Nidhruv Ravikumar Mohammed Arbaaz Sayed Chanaradh James Poonsuph Rijuvani Sehgal Manasi Mahesh Shirke Amer Harky |
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| Affiliation: | 1. School of Medicine, Queen''s university Belfast, Belfast, UK;2. Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK;3. Department of Congenital Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK;4. Liverpool Centre for Cardiovascular Science, University of Liverpool and Livepool Heart and Chest Hospital, Liverpool, UK;5. School of Medicine, Faculty of Health and life Science, University of Liverpool, Liverpool, UK;1. Division of Cardiology, Sanatorio de la Trinidad Palermo, Buenos Aires, Argentina;2. Echocardiography department, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México;3. Department of Cardiology and Heart Failure Clinic, Cardiovascular Clinic Santa Maria, University of Antioquia, Medellín, Colombia;4. Division of Cardiology, Kingston Health Science Center, Queen''s University, Kingston, Ontario, Canada;5. Division of Cardiology, Sanatorio Güemes, Buenos Aires, Argentina;6. Cardiovascular Services and Technology of Guatemala - Cardiosolutions, Guatemala City, Guatemala;7. Department of Cardiology and Heart Failure Unit, Sanatorio Güemes, Buenos Aires, Argentina;1. Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN;2. Department of Internal Medicine, Baptist Memorial Hospital, Memphis, TN;3. Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN;4. College of Medicine, University of Tennessee Health Science Center, Memphis, TN |
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| Abstract: | Septic cardiomyopathy (SCM) is increasingly recognized as a potential complication of septic shock; it is understood to be a reversible left ventricular systolic dysfunction. The presence of SCM in septic shock, in previous studies, infer a poorer prognosis as it significantly increases the mortality rate of patients to 70%-90% and its incidence varies from 18% to 40% of septic shock patients. The pathogenesis is unclear, but believed to be a combination of bacterial toxins, cytokines, nitric oxide, and cardiac mitochondrial dysfunction, that depresses intrinsic cardiac contractility. The presence of SCM can be diagnosed in patients using a bedside transthoracic echocardiogram which typically shows left ventricular ejection fraction <45% and right ventricular dilatation. For management, levosimendan provides a good hemodynamic response without increasing cardiac oxygen demand when compared to dobutamine, while more invasive techniques such as extracorporeal membrane oxygenation, and intra-aortic balloon pulsation are being explored as well as potential rescue strategies for patients with severe SCM. |
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