Heart function after severe hemorrhagic shock.
OBJECTIVE
Test whether brief deep hemorrhagic hypotension or prolonged moderate hemorrhagic hypotension impairs intrinsic heart function.


METHODS
Pentobarbital-anesthetized, non-anticoagulated rats were cannulated via the carotid artery. This study focuses on three main groups: 1) hemorrhage to a mean arterial blood pressure (MAP)=25 mm Hg for 1 h (1 h severe shock), 2) hemorrhage to MAP=40 mm Hg for 3 h (3 h moderate shock), 3) no hemorrhage (control). Hearts were either freeze-clamped in-situ for tissue analysis (n=6 per group) or were removed to study in vitro cardiac function and efficiency using a working heart perfusion (n=12 per group, glucose (11 mM)/palmitate (0.4 mM), 3% BSA buffer). Following perfusion, hearts were freeze-clamped and analyzed for free CoA, acetyl-, succinyl-, and malonyl-CoA, ATP content and for TNF-alpha content.


RESULTS
Isolated working hearts obtained following 1 h of severe shock generated 20% less hydraulic work than hearts obtained from control rats or rats subjected to 3 h of moderate shock. The cardiac efficiency (work/O2 consumption) was also significantly reduced with 1 h severe shock (0.76 +/- 0.07 after 15 min perfusion) versus control (0.96 +/- 0.06) or 3 h prolonged shock (1.10 +/- 0.09). Myocardial Co-A ester, ATP and TNF-alpha concentrations were not different between control and shocked hearts, although TNF-alpha concentrations increased significantly in all hearts during ex vivo perfusion.


CONCLUSIONS
Depth of hypotension is more important than duration in causing intrinsic cardiac dysfunction. This post-hemorrhagic cardiac dysfunction is not a result of substrate limitation to the heart, nor myocardial TNF-alpha accumulation, but is more likely a result of impaired transfer of energy from molecular oxygen into external cardiac work.
Kline
J A
JA
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA.
Thornton
L R
LR
Lopaschuk
G D
GD
Barbee
R W
RW
Watts
J A
JA
D000255:Adenosine Triphosphate / Q000378:metabolism; D000818:Animals; D003065:Coenzyme A / Q000378:metabolism; D004952:Esters / Q000378:metabolism; D006321:Heart / Q000187:drug effects / Q000503:physiopathology*; D006334:Heart Function Tests; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D007022:Hypotension / Q000503:physiopathology; D008297:Male; D010424:Pentobarbital / Q000494:pharmacology; D051381:Rats; D017207:Rats, Sprague-Dawley; D012771:Shock, Hemorrhagic / Q000378:metabolism / Q000503:physiopathology*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D004952:Esters; D006993:Hypnotics and Sedatives; D014409:Tumor Necrosis Factor-alpha; D000255:Adenosine Triphosphate; D010424:Pentobarbital; D003065:Coenzyme A