[Myocardial dysfunction and septic shock].
Myocardial dysfunction frequently accompanies severe sepsis and septic shock. It is now clear that such a myocardial depression, as evidenced by biventricular alteration, is present during the early phase of sepsis in most patients. Myocardial depression exists despite a fluid loading-dependent hyperdynamic state and usually recovers within 7 to 10 days in survivors. Myocardial dysfunction does not appear to be due to irreversible structural abnormalities nor to myocardial hypoperfusion, but rather linked to many circulating mediators including cytokines. At a cellular level, reduced myocardial contractility could be related in part to apoptosis and induced by both nitric oxide-dependent and nitric oxide-independent mechanisms. However, whatever the mechanism involved, it leads to calcium homeostasis abnormality. The present review describes both the diagnosis procedure and the molecular and cellular pathways of sepsis-induced myocardial depression.
Gibot
Sébastien
S
Service de réanimation médicale, Hôpital Central, CHU de Nancy, 29, avenue du Maréchal de Lattre de Tassigny, 54000 Nancy, France.
Lévy
Bruno
B
Nevière
Rémi
R
Cariou
Alain
A
Lesur
Olivier
O
D009202:Cardiomyopathies / Q000209:etiology*; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D012772:Shock, Septic / Q000150:complications* / Q000503:physiopathology*