Understanding cardiac failure in sepsis

Excerpt

Although dedicated to cardiac failure in sepsis, this short review covers also other aspects of hemodynamic alterations in sepsis, such as cardiac preload, afterload, and microcirculation. We believe that this is necessary as the degree of cardiac dysfunction is determined not only by cardiac contractility, but also by changes in afterload and preload. In practice, left ventricular (LV) afterload may exacerbate LV systolic dysfunction; on the other hand, venous return may be impaired by right ventricular (RV) systolic dysfunction. Fluid expansion and the consequent changes in LV filling pressures have to be interpreted in the context of the degree of LV diastolic function, which is frequently impaired in sepsis. Finally, each of the above has to be evaluated in the context of the adequacy of tissue perfusion. Such inadequacy can be manifested by markers of hypoperfusion such as elevated blood lactate and decreased oxygen venous saturation (SvO₂ and ScvO₂), although not without limitations. …