A look at the diastolic function in severe sepsis and septic shock - Critical Care Science (CCS)
Myocardial dysfunction in sepsis is a complex entity due to the dynamic adaptation of the cardiovascular system to the disease process, the host response, and the effects of resuscitation. The pathophysiology of this entity is multifactorial; systemic, cellular, and extracellular mechanisms have been described, including maldistribution of coronary blood flow, myocardial injury, complement-triggered (C5a) myocyte contractile failure, cytokine-induced neutrophil activation (tumor necrosis factor, interleukin-1β, interleukin-6), dysregulation of calcium handling, and cytopathic hypoxia due to mitochondrial dysfunction.(,)
Cardiovascular compromise is a central component of multiple organ dysfunction syndrome, an often fatal consequence of severe sepsis and septic shock. There is a sizable body of work on left ventricular systolic dysfunction in sepsis,(,) whereas other forms of myocardial dysfunction have been often overlooked. These variants include left ventricular diastolic dysfunction(–) and right ventricular dysfunction,(,) which have different treatment options and prognostic implications. Interestingly, all types of myocardial dysfunction can be present in isolation or in combination and can be fully reversible with resolution of critical illness.(,)
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Myocardial dysfunction in sepsis is a complex entity due to the dynamic adaptation of the cardiovascular system to the disease process, the host response, and the effects of resuscitation. The pathophysiology of this entity is multifactorial; systemic, cellular, and extracellular mechanisms have been described, including maldistribution of coronary blood flow, myocardial injury, complement-triggered (C5a) myocyte contractile failure, cytokine-induced neutrophil activation (tumor necrosis factor, interleukin-1β, interleukin-6), dysregulation of calcium handling, and cytopathic hypoxia due to mitochondrial dysfunction.(,)
Cardiovascular compromise is a central component of multiple organ dysfunction syndrome, an often fatal consequence of severe sepsis and septic shock. There is a sizable body of work on left ventricular systolic dysfunction in sepsis,(,) whereas other forms of myocardial dysfunction have been often overlooked. These variants include left ventricular diastolic dysfunction(-) and right ventricular dysfunction,(,) which have different treatment options and prognostic implications. Interestingly, all types of myocardial dysfunction can be present in isolation or in combination and can be fully reversible with resolution of critical illness.(,)
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