title: [Myocardial dysfunction in septic shock--a case report].
abstract: BACKGROUND
  Sepsis is characterized by generalized inflammatory response induced by infection. The incidence of myocardial dysfunction in sepsis is unknown as well as its impact on survival, independently other organ system dysfunction.
  
  
  METHODS
  A female patient, age 36, with clinical signs of septic shock was admitted to the Intensive Care Unit. After initial therapy of septic shock, patient was still haemodynamically unstable. Transthoracic echocardiography showed left ventricular dysfunction (EF = 20%), with mitral regurgitation 2-3+, tricuspid regurgitation 3+, and estimated systolic right ventricular pressure of 53 mm Hg. Inotropic drug, dobutamine, was initiated, which led to significant improvement of hemodynamic parameters. Eight days after the initiation of therapy the clinical improvement was observed and the control transthoracic echocardiography was performed. It showed the improvement in left ventricular size and function, with EF of 57%, and reduced mitral regurgitation to 2+, and tricuspid regurgitation to 1+.
  
  
  CONCLUSIONS
  A hyperdynamic state is typically present in sepsis. Myocardial dysfunction in sepsis is characterized by decreased ejection fraction, ventricular dilatation and impaired contractile response to volume loading. Cardiac output can be measured using pulmonary artery catheter, transthoracic and transoesophageal echocardiography, or by pulse contour analysis. In this patient, myocardial dysfunction was detected by echocardiography, which helped in clinical decision making to administer inotropic agent. The recovery of myocardial function was also confirmed by echocardiography.
  
  
  CONCLUSIONS
  Echocardiography can be used in septic patient for diagnosis of myocardial dysfunction, decision making, follow-up of the response to inotropic therapy, and detection of the complete recovery of cardiac function.
authors.affiliation: Klinicki centar Srbije, Beograd, Urgentni centar. nadaiaca@eunet.yu
authors.forename: Nada
authors.initials: N
authors.lastname: Popović
authors.forename: Dragan
authors.initials: D
authors.lastname: Mijusković
authors.forename: Vojislava
authors.initials: V
authors.lastname: Nesković
authors.forename: Ljubica
authors.initials: L
authors.lastname: Arsenijević
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Karamarković
authors.forename: Stefanović
authors.initials: S
authors.lastname: Branislava
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000209:etiology; D012772:Shock, Septic / Q000150:complications*; D018487:Ventricular Dysfunction, Left / Q000209:etiology