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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Septic cardiomyopathy : pathophysiology and prognosis

Abstract

Septic cardiomyopathy is a separate clinical entity clearly distinct from myocarditis on histological grounds. Physiologically it characteristically presents, unlike other types of heart failure, with normal or increased cardiac output with normal or low preload pressures & a reduced systemic vascular resistance. Speckle tracking echocardiography is now the diagnostic tool of choice for detecting subtle changes in myocardial dysfunction

Ventricular contractility is invariably reduced to some degree in septic shock but, if severe ventricular dysfunction with low blood pressure and a falling cardiac output develops, mortality is twice that of septic shock without cardiac organ failure. However if the patient survives the episode of sepsis, septic cardiomyopathy is largely reversible since the changes are predominantly functional rather than structural although it is as yet uncertain if this applies when contraction band necrosis has developed as a result of the use of high doses of vasopressors.

Key words: sepsis, septic shock, septic cardiomyopathy, sepsis induced cardiomyopathy, ventricular contractility, speckle tracking echocardiography, ventricular re-synchronisation

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Incessant ventricular tachycardia as a manifestation of septic cardiomyopathy – case report

Abstract

Incessant ventricular tachycardia is defined as frequent, repetitive and persistent ventricular arrhythmia or appropriate activation of an implantable cardioverter-defibrillator when present, which occurs more than three times within 24 hours and is ultimately followed by hemodynamic collapse. It is usually associated with structural heart disease ischaemia and often has a poor prognosis. The treatment strategy involves defining the aetiology through a targeted medical history and a physical examination (toxins, drugs, etc.), a 12-lead ECG, laboratory tests (electrolytes, etc.) and the detection of ischaemia. This report presents a case of young puerpera with peripartal sepsis, with no evidence of peripartal cardiomyopathy or ischaemia, which manifested itself initially with an arrhythmic cardiac arrest and a sequentially lethal outcome after a prolonged resuscitation procedure.

Keywords: peripartal sepsis, septic shock, septic cardiomyopathy, electrical storm, ventricular tachycardia

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