Editor: Vasilios E. Papaioannou

Series Title: Frontiers in Myocardia

Septic Cardiomyopathy: from bench-to-bedside

Volume 1

eBook: US $129 Special Offer (PDF + Printed Copy): US $219
Printed Copy: US $155
Library License: US $516
ISSN: 2451-8344 (Print)
ISSN: 2451-8352 (Online)
ISBN: 978-1-68108-061-1 (Print)
ISBN: 978-1-68108-060-4 (Online)
Year of Publication: 2015
DOI: 10.2174/97816810806041150101

Introduction

Frontiers in Myocardia is an eBook series which compiles information about the structure and function of myocardial (the heart muscles) and includes updated reviews on the recent developments in the treatment of associated diseases such as angina, cardiac arrhythmias and myocardial infarction.

Advances in research on clinical sepsis in the last few decades have lead to the use of new concepts and treatment paradigms that have been tested and implemented in the clinical setting of Intensive Care Units around the world. An integrative approach towards understanding the pathophysiology of cardiac dysfunction in septic patients can, therefore, lead to better patient outcomes.

The first volume of this series, Septic Cardiomyopathy: from bench-to-bedside, integrates new and old information about the molecular mechanisms, histopathological and electrophysiological alterations with novel findings for diagnosing treating septic cardiomyopathy. This eBook attempts to bridge the gap between basic and clinical scientists and presents new data on different aspects of cardiac physiology during critical illness in a single volume. Chapters in this volume also cover cardiovascular changes that occur as a consequence of sepsis including metabolic, mitochondrial arrhythmic changes.

This eBook will add significant value to medical students, cardiac physicians and medical scientists engaged in the field of critical care medicine.

Preface

Severe sepsis and septic shock are the most common scenarios that a caring physician may deal with, when he is treating a critically ill patient in the Intensive Care Unit (ICU). Moreover, early signs of severe infection associated with organ dysfunction might appear when a patient is treated in a medical or surgical ward, within a hospital. Thus, early diagnosis and prompt treatment are of paramount importance for improving survival of these patients.

One of the most significant complications of sepsis is the cardiovascular compromise, mostly due to a vasoplegia induced by different cytokines that are produced during systemic inflammation. In addition, both left and right systolic and diastolic dysfunction has been proven to occur in the course of severe sepsis. This cardiomyopathy, as has been shown from Parrillo and Parker in the 80’ using portable radionuclide cardiac imaging and thermodilution cardiac output measurements, is usually reversible within 7-10 days, whereas different echocardiographic studies by Jardin and Baron since the 90’ have confirmed left and right systolic dysfunction. In these cases, conventional estimators of ventricular function, such as cardiac output and ejection fraction (EF), lack both sensitivity and specificity for accurate assessment of heart performance, either due to significant afterload reduction or due to severe pulmonary hypertension and alterations in left ventricular compliance.

There is a lot of debate in the literature regarding potential pathogenetic mechanisms of septic cardiomyopathy, such as membrane ionic current remodeling, cardiomyocyte apoptosis, different circulating depressive factors or autonomic nervous system (ANS) output effects. In any case, both animal experiments and human echocardiographic studies reveal that intrinsic mechanisms can be adaptative, leading to a sort of myocardial hibernation, or maladaptative, producing severe cellular stress with associated necrosis or apoptosis. Current treatment of septic shock other than antimicrobial treatment include fluid load, vasopressors and/or positive inotropic agents, which might induce calcium overload and deteriorate cellular stress, similar with band necrosis observed in stress-associated cardio-myopathy or the apical ballooning syndrome.

In conclusion, we think that the topic of septic cardiomyopathy remains significantly obscured, since there is a lot but scarred information in the literature concerning molecular or electrophysiological pathophysiological mechanisms, diagnostic and therapeutic interventions, monitoring tools, and specific treatment options.

The aim of this ebook is to gather scientists from different disciplines in order to provide thorough and concise information regarding all aspect of this ‘disease’, from electrophysiological and cellular alterations to clinical, laboratory and imaging technological advances. In addition, it will present novel data concerning new promising treatments, in the context of septic shock management in the ICU.

Vasilios E. Papaioannou

Democritus University of Thrace,
Intensive Care Unit, Alexandroupolis Hospital,
Dragana 68100,
Greece,
Tel: 0030255105083
E-mail: vapapa@med.duth.gr

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