title: Septic cardiomyopathy - A not yet discovered cardiomyopathy?
abstract: Myocardial depression in human sepsis was only unequivocally proven in the 1980s by the group of Parrillo, who used nuclear imaging techniques to measure heart volumes and function in intensive care patients. Heart failure in sepsis is frequently masked by a seemingly normal cardiac output. However, relative to the lowered systemic vascular resistance - resulting in a reduced afterload - cardiac outputs and ventricular ejection fractions are often not adequately enhanced. This septic cardiomyopathy (impairment of the heart within the scope of systemic sepsis) involves both the right and the left ventricles, and is potentially reversible. In response to volume substitution, the heart can be considerably enlarged. The cardiomyopathy is not primarily hypoxic in nature, but may be aggravated by ischemia. Autonomic dysfunction, documented by a reduced heart rate variability and impaired baroreflex and chemoreflex sensitivities, forms part of the disease entity. The severity of myocardial depression correlates with a poor prognosis. Noninfectious systemic inflammatory response syndrome can give rise to an analogous disease entity, namely, systemic inflammatory response syndrome cardiomyopathy.The etiology of septic cardiomyopathy is multifactorial. Several candidates with a potential pathogenetic impact on the heart were identified: bacterial toxins; cytokines and mediators including tumour necrosis factor-alpha, interleukin-1 and nitric oxide; cardiodepressant factors; oxygen reactive species; and catecholamines. Symptomatic treatment consists of volume substitution and catecholamine support; causal therapeutic approaches aiming at an interruption of the proinflammatory mediator cascades are being tested.
authors.affiliation: Department of Medicine III, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Muller-Werdan
authors.forename: Michael
authors.initials: M
authors.lastname: Buerke
authors.forename: Henning
authors.initials: H
authors.lastname: Ebelt
authors.forename: Konstantin M
authors.initials: KM
authors.lastname: Heinroth
authors.forename: Anja
authors.initials: A
authors.lastname: Herklotz
authors.forename: Harald
authors.initials: H
authors.lastname: Loppnow
authors.forename: Martin
authors.initials: M
authors.lastname: Ruß
authors.forename: Frithjof
authors.initials: F
authors.lastname: Schlegel
authors.forename: Axel
authors.initials: A
authors.lastname: Schlitt
authors.forename: Hendrik B
authors.initials: HB
authors.lastname: Schmidt
authors.forename: Gerold
authors.initials: G
authors.lastname: Söffker
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan