Histologic Pathologies of the Myocardium in Septic Shock
- 1 April 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Shock
- Vol. 39 (4), 329-335
- https://doi.org/10.1097/shk.0b013e318289376b
Abstract
Myocardial depression in septic shock is well known, but its pathophysiological genesis is incompletely understood. To assess the incidence and extent of stress-induced histologic myocardial alterations in septic shock, a prospective, observational, combined clinical and postmortem study was conducted, and 20 patients dying from septic shock were included. Exclusion criteria were younger than 18 years, pregnancy, open heart surgery or cardiopulmonary resuscitation, acute neurologic diseases, pheochromocytoma, and forensic autopsy. A systematic macropathologic evaluation was performed. Nine predefined heart sections were histologically screened for myocytolysis, interstitial fibrosis, contraction band necrosis, mononuclear infiltrates, interstitial edema, and tissue hemorrhage. Stress-induced pathologies were found in 90% to 100% of patients in all heart sections (myocytolysis, 100%; interstitial fibrosis, 100%; contraction band necrosis, 95%; mononuclear infiltrates, 90%; interstitial edema, 90%; tissue hemorrhage, 30%). The incidence and extent of contraction band necrosis, mononuclear infiltrates, and myocytolysis did not differ between sexes; patients with or without chronic β-blocker, calcium antagonist, and/or statin premedication; or between the binary use of different catecholamine agents (all comparisons P > 0.05). The maximum epinephrine dose correlated with the overall extent of mononuclear infiltrates (Spearman-Rho, r = 0.704; P = 0.05) and myocytolysis (Spearman-Rho, r = 0.933; P = 0.001). Maximum norepinephrine doses correlated with the extent of mononuclear infiltrates in the left ventricular anterior wall (Spearman-Rho, r = 0.519; P = 0.02). The total duration of catecholamine therapy was correlated with the extent of mononuclear infiltrates in the apex (Spearman-Rho, r = 0.571; P = 0.009) and right atrium (Spearman-Rho, r = 0.535; P = 0.02). In conclusion, our results suggest that histologic lesions potentially indicative of stress-induced cardiotoxicity can be observed in most patients dying from septic shock.Keywords
This publication has 21 references indexed in Scilit:
- Structural Changes of the Heart During Severe Sepsis or Septic ShockShock, 2012
- Effects of esmolol on systemic and pulmonary hemodynamics and on oxygenation in pigs with hypodynamic endotoxin shockIntensive Care Medicine, 2011
- How to protect the heart in septic shock: A hypothesis on the pathophysiology and treatment of septic heart failureMedical Hypotheses, 2010
- Sympathetic Overstimulation During Critical Illness: Adverse Effects of Adrenergic StressJournal of Intensive Care Medicine, 2009
- Association of arterial blood pressure and vasopressor load with septic shock mortality: a post hoc analysis of a multicenter trialCritical Care, 2009
- MYOCARDIAL DEPRESSION IN SEPSISShock, 2008
- Combined milrinone and enteral metoprolol therapy in patients with septic myocardial depressionCritical Care, 2008
- Mechanisms of sepsis-induced cardiac dysfunctionCritical Care Medicine, 2007
- MYOCARDIAL STRUCTURAL CHANGES IN LONG-TERM HUMAN SEVERE SEPSIS/SEPTIC SHOCK MAY BE RESPONSIBLE FOR CARDIAC DYSFUNCTIONShock, 2007
- 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions ConferenceIntensive Care Medicine, 2003