1.1. What is Sepsis Associated Cardiac Injury?
Sepsis is an extremely serious and potentially life-threatening condition that is caused due to the body’s immune response to an infection. In severe cases Sepsis often leads to major organ failure and ultimately death of the patient.
Sepsis is one of the most common causes of mortality in the elderly or critically ill patients and affects more than million people every year. However, with new treatments and ongoing research the mortality rate has come down a fair bit but Sepsis is still considered to be an extremely serious medical condition.
Sepsis can affect any major organ of the body and the heart is no exception. In fact, cardiac injury is one of the more common complications of Sepsis and is responsible for significant mortality. It is believed that around 70% of people with septic shock have some degree of cardiac dysfunction after the condition is treated.
The primary aim of this article is to make the reader aware of the common causes, the clinical features, the management options and the long term prognosis of Sepsis Associated Cardiac Injury.
Pathophysiology of Sepsis-Associated Cardiac Injury
The pathophysiology of Sepsis Associated Cardiac Injury can be best understood by dividing it in three segments namely the role the immune system plays in sepsis, the inflammatory response, and how it affects the cardiac health.
2.1 Role of Immune System in Sepsis
The primary function of the immune system in the body is to protect the body from any foreign substance like bacteria or a virus. The immune system does this by releasing proinflammatory cytokines which are hormones that ultimately lead to the production of antibodies and T cells which fight the infection.
2.2 Inflammatory Response in Sepsis
What happens in sepsis is that this immune system malfunctions leading to excessive production of cytokines due to an infection. This then tends to cause damage to the lining of the blood vessels which then leads to tissue edema and vascular permeability.
2.3 Effects of Sepsis on the Cardiovascular System
It is this malfunction of the immune system in sepsis that ultimately damages the heart resulting in sepsis associated cardiac injury. Sepsis can cause a significant decrease in cardiac output, impaired ventricular function, and myocardial depression and it is the combination of this these factors which lead to Sepsis Associated Cardiac Injury.
Clinical Presentation of Sepsis-Associated Cardiac Injury
3.1 Symptoms of Sepsis-Associated Cardiac Injury
At times the symptoms of Sepsis Associated Cardiac Injury may overlap with the symptoms of sepsis but in almost all the cases the patient will experience chest pain with breathlessness along with confusion. In severe cases the patient may go into a septic shock which is characterized by low blood pressure, decreased urine output, and altered mental state.
3.2 Diagnostic Tests for Sepsis-Associated Cardiac Injury
To definitively diagnose Sepsis Associated Cardiac Injury the physician will perform a battery of tests. This will begin by conducting an electrocardiogram and do blood tests to look at the troponin levels. The echocardiogram will show abnormalities in the functioning of the heart and the troponins will be elevated in cases of Sepsis Associated Cardiac Injury. An ECG will also be done to assess for electrical activity of the heart.
Management of Sepsis-Associated Cardiac Injury
4.1 Treatment of Sepsis
To treat Sepsis Associated Cardiac Injury, the first step is to address the underlying infection that caused the patient to develop the condition. This is done by a course of antibiotics.
Another important factor in this treatment is fluid resuscitation to maintain adequate perfusion to the major organs of the body and prevent them from getting damaged.
4.2 Hemodynamic Support
Often people with Sepsis Associated Cardiac Injury need hemodynamic support in order to maintain blood pressure and adequate cardiac output. This is done by use of vasopressors. If significant cardiac dysfunction is noticed then the patient may also be provided with inotropic agents to improve the myocardial contractility.
4.3 Cardiac-Specific Therapies
Additionally, the patient will also be given targeted cardiac specific therapies to deal with Sepsis Associated Cardiac Injury like use of an ECMO device or intraaortic balloon pump to improve cardiac function.
Prognosis and Long-Term Outcomes
5.1 Risk of Recurrent Sepsis and Sepsis-Associated Cardiac Injury
If a person has already had a sepsis event along with Sepsis Associated Cardiac Injury, then the chances of having a recurrent episode is quite high. Additionally, these people may also be at an increased risk for developing other cardiovascular conditions which may not have a good long term prognostic value.
This is the reason why such patients are closely monitored and observed with periodic checkups to detect any cardiac dysfunction early and provide prompt management before any serious complications develop.
5.2 Relationship Between Sepsis-Associated Cardiac Injury and Long-Term Cardiovascular Morbidity and Mortality
There are many studies that have implied that Sepsis Associated Cardiac Injury influences the long-term prognosis of the patient specifically with regard to any cardiovascular condition developing later on in that the mortality rate in such patients is quite high due to cardiovascular ailments.
Sepsis is an extremely serious and potentially life-threatening condition caused by a dysregulated immune response to an infection. Sepsis affects almost all the major organs of the body inflicting significant damage including the heart. Sepsis Associated Cardiac Injury is one such impact that sepsis has on the cardiovascular system.[1, 2]
Sepsis Associated Cardiac Injury requires immediate detection and prompt treatment to reduce the chances of mortality. However, with prompt treatment the outcomes and prognosis of the patient significantly improves. Early treatment also means that the patient will have a reduced risk of developing cardiovascular ailments later on in life as a result of Sepsis Associated Cardiac Injury.[1, 2]
However, in order to open up new avenues with regard to the treatment options available for Sepsis Associated Cardiac Injury more research needs to be done and is ongoing.[1, 2]