Abstract
Sepsis is a very frequent diagnosis in intensive care units. It is associated with
a high mortality rate and often affects the cardiovascular system. Moreover, sepsis
is the most common form of shock and is often also accompanied by acute organ failure
such as myocardial dysfunction. Besides vasoplegia through decrease of systemic vascular
resistance, an acute reduction of myocardial contractility and ventricular dilation
are the typical signs of sepsis-induced myocardial dysfunction. With the increased
availability of bedside transthoracic echocardiography over the last few years, the
diagnosis of cardiomyopathy is verified much more frequently in septic patients. Given
that the diagnosis is highly complex and characterized by different origins as well
as diverse pathogens, it is difficult to make a prediction regarding a prognosis.
However, research has shown that it is highly likely that absence of normokinesia
will have a negative influence on the prognosis. The underlying pathophysiological
mechanisms of sepsis-induced myocardial dysfunction are not completely understood.
Infective toxin binding via toll-like receptors to different cell types (such as macrophages,
endothelial cells and directly to cardiomyocytes), which leads to increased release
of cytokines as well as the activation of the coagulation and the complement system.
Additionally, the release of intracellular calcium is impaired and mitochondrial cell
respiration is altered resulting in reduced contractility. Despite these findings
in recent literature, a specific therapy of these cellular dysfunctions is so far
not yet available. Patients should be treated according to both the procedures outlined
by the Surviving Sepsis Campaign (especially with the early application of anti-infective
therapy), and against acute heart failure, with the goal of normokinesia. Further
studies are warranted to investigate the underlying mechanisms in more detail and
potentially provide specific and targeted therapeutic approaches which would be of
high clinical importance.
