Cardiac Dysfunction due to Sepsis

  • Kabul Priyantoro Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia and National Cardiovascular Center Harapan Kita, Jakarta
  • Soroy Lardo Division of Tropical Disease and Infection, Department of Internal Medicine, Gatot Soebroto Hospital, Jakarta
  • Yoga Yuniadi Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia and National Cardiovascular Center Harapan Kita, Jakarta

Abstract

Sepsis is a condition where bacteremia persist and precede by SIRS sign, in a severe condition sepsis can manifest as septic shock and refractory septic shock with very high mortality rate, up to 50% during hospitalization, almost equalize death due to myocardial infarction. In a severe sepsis at least one of organ dysfunction is present, cardiovascular is one of the most frequent affected organ system in severe sepsis and almost always affected during septic shock. During sepsis depression of cardiac systolic and diastolic func-tion characterized by bi-ventricular impairment of contractility, decrease in ventriclular compliance which manifest as subsequent reduction in left ventricular ejection fraction and LV stroke work index. The pathophysi-ology of cardiac depression during sepsis remain unclear up to now, but many evidence showed that circulating cardio toxic agent (IL – 1, IL – 8, C3a), endotoxin (LPS), cytokine (IL – 1, IL – 6, TNF – a), endothelin – 1 (ET – 1), nitric oxide (NO), prostanoid (Tromboxan & Prostasiklin), and adhesion molecule (intercellular adhesion molecule-1 & vascular cell adhe-sion molecule-1) play important role in depressing cardiac function during sepsis. Definitive therapy regarding cardiac dysfunction during sepsis is still unknown, but adequate supportive management in maintaining adequate preload continued by inotropic and or vasopressor with low dose cor-ticosteroid, low dose nitroglycerine (in selected patients) and statin are prove in clinical trial effective in providing better outcome. Poor cardiac function in sepsis is related to poor outcome during hospitalization. This article discus about cardiac dysfunction, pathophysiology and supportive management in adult with sepsis.

Downloads

Download data is not yet available.

References

Merx MW and Weber C. Sepsis and the ?eart. Circulation. 2007;116;793-802.

Wheeler AP. Recent Developments in the Diagnosis and Man-agement of Severe Sepsis. Chest. 2007;132;1967-1976.

Hunter JD and Doddi M. Sepsis and the heart. Br J Anaesth. 2010; 104: 3–11.

Maeder M, Fehr T, Rickli ?, and Ammann P. Sepsis-Associated Myocardial Dysfunction Diagnostic and Prognostic Impact of Cardiac Troponins and Natriuretic Peptides. Chest. 2006; 129:1349–1366.

Sharma AC. Sepsis – Induced Myocardial Dysfunction. Shock. 2007;28: 265-269.

Kumar V, Abbas AK, Fausto N. Robbins and Cotran Pathologic Basis of Disease. 7th ed. Elsevier Inc; 2005.

Silbernagl S: ?eart and Circulation. Silbernagl S, Lang F. Color Atlas of Pathophysiology, Thieme, 2000.p.230 – 234.

Broderick KE, Feala J, McCulloch A, Paternostro G, Sharma VS, Pilz R, and Boss G. The nitric oxide scavenger cobinamide profoundly improves survival in a Drosophila melanogaster model of bacterial sepsis. Faseb J. 2006; 20: 1865–1873.

Hauser B, Bracht ?, Matejovic M, Radermacher P, and Venkatesh B. Nitric Oxide Synthase Inhibition in Sepsis? Lessons Learned from Large-Animal Studies. Anesth Analg. 2005;101:488 –498.

McGown CC and Brookes ZLS. Beneficial effects of statins on the microcirculation during sepsis: the role of nitric oxide. Br J Anaesth. 2007; 98:163–175.

Guntur A?.Sepsis. In: Sudoyo AW, Satyohadi B, Alwi I, Simadi-brata MK, Setiati S, editors. Buku ajar Ilmu Penyakit Dalam. 5th ed. Jakarta: Pusat penerbitan Departemen Ilmu Penyakit Dalam FKUI; 2009.p.2889-2895.

Otero RM, Nguyen ?B, ?uang DT, Gaieski DF, Goyal M, Gunnerson KJ, Trzeciak S, Sherwin R, ?olthaus CV, Osborn T, Rivers EP. Early Goal-Directed Therapy in Severe Sepsis and Septic Shock Revisited: Concepts, Controversies, and Contem-porary Findings. Chest. 2006;130; 1579-1595.

Overgaard CB and Dzavík V. Inotropes and Vasopressors: Re-view of Physiology and Clinical Use in Cardiovascular Disease. Circulation. 2008;118;1047-1056.

Hollenberg Steven M. Vasopressor Support in Septic Shock. Chest. 2007;132:1678-1687.

Duraira Lj, and Schmidt . Fluid Therapy in Resuscitated Sepsis. Chest. 2008; 133:252–263.

Annane D, Bellissant E, Bollaert PE, Briegel J, Confalonieri M, De Gaudio R, Keh D, Kupfer Y, Oppert M, Meduri GU. Corticosteroids in the Treatment of Severe Sepsis and Septic Shock in Adults. JAMA. 2009;301:2362-2375.
Views & Downloads
Abstract views: 567   
PDF (Bahasa Indonesia) downloads: 736   
How to Cite
Priyantoro, K., Lardo, S., & Yuniadi, Y. (1). Cardiac Dysfunction due to Sepsis. Indonesian Journal of Cardiology, 31(3), 177-86. https://doi.org/10.30701/ijc.v31i3.131
Section
Review Article