Myocardial dysfunction and septic shock |
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Authors: | Gibot Sébastien Lévy Bruno Nevière Rémi Cariou Alain Lesur Olivier |
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Institution: | Service de réanimation médicale, H?pital Central, CHU de Nancy, 29, avenue du Maréchal de Lattre de Tassigny, 54000 Nancy, France. |
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Abstract: | 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. |
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