Disfunção miocardica na spse

RBTI / ARTIGO DE REVISÃO

Disfunção Miocárdica na Sepse*
Myocardial Dysfunction in Sepsis
Ludhmila Abrahão Hajjar1, Constantino José Fernandes Júnior2, Erick Sessa Mercon1, Aécio Flavio T Góis1, Elias Knobel2 , Liliane Kopel3 , Silvia Gelas Lage4

SUMMARY BACKGROUND AND OBJECTIVES: Myocardial dysfunction in sepsis occurs in approximately 40% of the patients, and is responsible for significant increase of mortality. The objective of this article is to review myocardial dysfunction in sepsis, regarding its pathogenetic mechanisms and clinical consequences. CONTENTS: Although its pathogenesis and clinical consequences remain incompletely understood, myocardial dysfunction plays a clear role in human septic shock. Septic myocardial depression in humans has been seen to be characterised by reversible ventricular dilation, decreased systolic function, and decreased response to both fluid resuscitation and catecholamine estimulation, all in the presence of a hyperdynamic circulation. This phenomenon is related to the presence of circulating myocardial depressant factors, like TNFα IL-1 and nitric oxide. CONCLUSIONS: Our current approach to cardiac dysfunction in patients with septic shock is still aimed at goals of reestablishing organ and tissue perfusion and oxygen delivery by fluid resuscitation and inotropic or vasopressor therapy. However, as we continue to understand the cellular mechanisms of organ dysfunction, the hope is that there will be exciting new strategies and therapeutic options to reduce mortality of critical patients. Key Words: Myocardial dysfunction, myocardial depression, sepsis

sepse é uma entidade complexa definida como uma síndrome de resposta inflamatória sistêmica à infecção, caracterizada e modulada por vários mediadores inflamatórios e antiinflamatórios1,2. Nos pacientes críticos a sepse é um problema crescente, dada sua alta prevalência e altas taxas de mortalidade, variando de 25% a 70%3. A morbimortalidade da sepse, é em grande parte