Sepsis-induced cardiac dysfunction: a review of pathophysiology

Abstract

It is well known that cardiac dysfunction in sepsis is associated with significantly increased mortality. The pathophysiology of sepsis-induced cardiac dysfunction can be summarized as involving impaired myocardial circulation, direct myocardial depression, and mitochondrial dysfunction. Impaired blood flow to the myocardium is associated with microvascular dysfunction, impaired endothelium, and ventriculo-arterial uncoupling. The mechanisms behind direct myocardial depression consist of downregulation of β-adrenoceptors and several myocardial suppressants (such as cytokine and nitric oxide). Recent research has highlighted that mitochondrial dysfunction, which results in energy depletion, is a major factor in sepsis-induced cardiac dysfunction. Therefore, the authors summarize the pathophysiological process of cardiac dysfunction in sepsis based on the results of recent studies.

Keywords: heart; mitochondria; pathophysiology; sepsis.

Figure 1.

The number of publications per year on sepsis-induced cardiac dysfunction, obtained by searching for “sepsis,” “cardiac dysfunction,” “myocardial dysfunction,” and “cardiomyopathy” in PubMed. The number was calculated from January 1, 1990 to December 31, 2019.

Figure 2.

Pathophysiology of sepsis-induced cardiac dysfunction.