septic myocarditis

Septic cardiomyopathy, also known as sepsis-induced cardiomyopathy (SICM) or sepsis-induced myocardial dysfunction (SIMD), is a condition characterized by reversible left ventricular dilatation and decreased contractility of the heart muscle. This condition occurs in patients with severe sepsis or septic shock, where the body's inflammatory response to an infection causes damage to the heart muscle.

Key Features:

• Reversible left ventricular dilatation
• Decreased contractility of the heart muscle
• Associated with severe sepsis or septic shock

Causes and Risk Factors:

• Severe sepsis or septic shock caused by infections such as pneumonia, bacteremia, or peritonitis
• Systemic inflammation and release of inflammatory mediators
• Oxidative stress and endogenous damage-associated molecular patterns (DAMPs)

Symptoms and Diagnosis:

• Symptoms may include fever, chills, tachycardia, and increased respiratory rate
• Diagnosis is often made based on clinical presentation, laboratory findings, and echocardiography

Treatment and Prognosis:

• Treatment focuses on addressing the underlying infection and sepsis with antibiotics, fluid resuscitation, and supportive care
• Prognosis is generally good if treated promptly and effectively, but mortality rates can be high if left untreated or undertreated.

References:

[6] Septic cardiomyopathy is a complication of sepsis-related cardiovascular failure, characterized by reversible left ventricular dilatation and decreased contractility. [7] Sepsis-induced cardiomyopathy (SICM), or sepsis-induced myocardial dysfunction (SIMD), is an increasingly recognized form of transient cardiac dysfunction in the septic patients. [8] Patients with sepsis may develop acute cardiac dysfunction, termed septic cardiomyopathy, which is a global but reversible dysfunction of both sides of the heart.

Septic Myocarditis Signs and Symptoms

Septic myocarditis, also known as septic cardiomyopathy, is a condition where the heart muscle becomes inflamed due to a severe infection, such as sepsis. The signs and symptoms of septic myocarditis can be subtle early in the illness but become more pronounced as the condition progresses.

Common Signs and Symptoms:

• Difficulty breathing: This can be a sign of septic myocarditis, especially if it's accompanied by other symptoms like chest pain or shortness of breath.
• Chest pain or discomfort: Chest pain is a common symptom of septic myocarditis, which can feel like a heart attack. However, unlike a typical heart attack, the pain may not improve with rest.
• Fever: A high fever is often present in patients with septic myocarditis, indicating an underlying infection.
• Fatigue or exercise intolerance: Patients with septic myocarditis may experience fatigue or shortness of breath even when engaging in light physical activities.
• Shortness of breath: This can be a sign of heart failure, which can occur if the inflammation is severe and untreated.
• Swelling of the legs, ankles, or feet: Fluid buildup in the body due to heart failure can cause swelling in these areas.

Other Possible Symptoms:

Diagnostic Tests for Septic Myocarditis

Septic myocarditis, also known as septic cardiomyopathy (SCM), is a condition where the heart muscle becomes inflamed due to a severe infection. Diagnosing septic myocarditis can be challenging, but several diagnostic tests can help confirm the condition.

• Echocardiography: This non-invasive test uses sound waves to create images of the heart and its function. Echocardiography is considered the cornerstone for diagnosing septic cardiomyopathy (SCM) [12][14][15]. It can help identify decreased contractility, which is a hallmark of SCM.
• Blood tests: Blood tests can also aid in diagnosing septic myocarditis by checking for markers of inflammation and cardiac damage. These may include tests to check for troponin, creatinine kinase (CK), C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR) [3].
• Imaging tests: Imaging tests such as cardiac magnetic resonance imaging (MRI) can help confirm the diagnosis of septic myocarditis and determine its severity [9][10].

Key Points

• Echocardiography is a crucial diagnostic tool for identifying septic cardiomyopathy.
• Blood tests can aid in diagnosing septic myocarditis by checking for markers of inflammation and cardiac damage.
• Imaging tests such as cardiac MRI can help confirm the diagnosis and determine the severity of septic myocarditis.

References

[1] Sepsis is a significant cause of mortality, but sepsis-induced cardiomyopathy (SCM) is not well-characterized with regard to prognosis or treatment [11]. [2] The reported prevalence of SCM varies widely from 10% to 70% [11]. [3] Blood tests can help diagnose myocarditis by checking for damage to the heart tissue and inflammation in the body [4]. [9] Echocardiography is the cornerstone for diagnosing septic cardiomyopathy (SCM) [12]. [10] Cardiac MRI serves as a reference standard non-invasive test for diagnosing myocarditis [9].

Treatment Options for Septic Myocarditis

Septic myocarditis, also known as sepsis-induced cardiomyopathy, is a condition where the heart muscle becomes inflamed and damaged due to an overwhelming infection in the body. The treatment of septic myocarditis focuses on addressing the underlying infection and supporting the heart function.

Inotropic Drugs

According to search result [7], inotropic drugs are suggested for septic patients with low cardiac output after optimization of fluid therapy. Norepinephrine is often the first choice among these medications, as it can help increase blood pressure and improve cardiac output.

Levosimendan

Search result [4] highlights levosimendan as an attractive therapy for septic cardiomyopathy. This medication targets cardiomyocyte calcium signaling, which is known to be affected in septic myocarditis. Levosimendan has been shown to be highly efficacious and safe in managing sepsis and sepsis-induced cardiomyopathy [9].

Corticosteroids

Search result [8] mentions methylprednisolone as a corticosteroid that can alleviate symptoms and reduce myocardial injury markers in serum. However, some patients may still experience cardiac complications despite treatment.

Other Treatments

In addition to these specific treatments, septic myocarditis is often managed with general supportive care, including fluid therapy, vasopressors, and mechanical ventilation as needed. The goal of treatment is to stabilize the patient's condition and prevent further cardiac damage.

References:

• [7] YC Liu (2017) - Inotropic drugs are suggested for septic patients with low cardiac output after optimization of fluid therapy.
• [4] M L’Heureux (2020) - Levosimendan is an attractive therapy for septic cardiomyopathy because it targets cardiomyocyte calcium signaling which is known to be affected in septic myocarditis.
• [9] Q Guan (2023) - Conclusion: Levosimendan is highly efficacious and safe in the management of sepsis and sepsis-induced cardiomyopathy.

Differential Diagnoses of Septic Myocarditis

Septic myocarditis, also known as sepsis-induced cardiomyopathy (SCM), is a condition where the heart muscle becomes inflamed and dysfunctional due to a severe infection. When diagnosing septic myocarditis, it's essential to consider other conditions that may present with similar symptoms.

Other Differential Diagnoses:

• Catecholamine- or stress-induced cardiomyopathy: This condition can also cause left ventricular dysfunction and is often triggered by severe emotional or physical stress.
• Myocarditis: An inflammatory disease of the heart muscle, which can be caused by infections, immune system activation, or exposure to certain drugs.
• Takotsubo cardiomyopathy: A reversible condition where the heart muscle becomes weakened due to intense emotional or physical stress.
• Pericardial diseases: Conditions affecting the sac surrounding the heart, such as pericarditis or cardiac tamponade.

Key Features to Distinguish:

When differentiating septic myocarditis from other conditions, consider the following key features:

• Rapid progression: Septic myocarditis often progresses rapidly due to the severe infection.
• Left ventricular dysfunction: Both septic myocarditis and catecholamine- or stress-induced cardiomyopathy can cause left ventricular dysfunction.
• Immune system activation: Myocarditis is characterized by immune system activation, which may not be present in septic myocarditis.

References:

• [1] Sepsis-induced cardiomyopathy (SCM) may be defined as depressed intrinsic contractility induced by sepsis. The reported prevalence of SCM varies widely from 10% to 70%. [2]
• Another differential diagnosis of septic cardiomyopathy is catecholamine- or stress-induced cardiomyopathy, which can also cause left ventricular dysfunction.
• Myocarditis is an inflammatory disease of the heart muscle, which can be caused by infections, immune system activation, or exposure to certain drugs. [3]

Note: The references provided are based on the search results within the context and may not reflect the most up-to-date information.