Constantino José Fernandes

Myocardial depression in sepsis.

Since the ancient Greeks, we have learned that the pathophysiology of the human diseases relies on blood-borne humoral factors. This was the case with the sepsis myocardial depression, whose associated morbidity and mortality remained untouched during the last decades. Despite the growing knowledge of the possible involved mechanisms, our understanding of this serious condition is still in its infancy. Controversies have surrounded the real origin of septic-induced myocardial dysfunction, and it has been ascribed to inflammatory mediators, NO generation, interstitial myocarditis, coronary ischemia, calcium trafficking, endothelin receptor antagonist, and apoptosis. Although not fully understood, myocardial injury/depression remains a challenge for critical care practitioners.

Interstitial myocarditis in sepsis

Abstract Data indicate that the myocardial histopathologic findings in human sepsis are both more extensive and severe than those described in experimental models with endotoxin/septic shock.

How to monitor myocardial ischemia

Myocardial ischemia detection and monitoring has crucial significance on clinical management and prognosis. Several methods are currently used to monitor ischemia and new techniques have recently become available for clinical use.The electrocardiogram (ECG) plays a central role in the evaluation of patients with suspected myocardial ischemia. ECG monitoring is important to detect not only rhythm disturbances but also ST-segment changes, indicative of myocardial ischemia. Exercise stress testing still remains the method of choice for risk stratification after myocardial infarction. Signal-averaged ECG can be used to assess the risk of future life-threatening arrhythmias in selected patients.New sensitive biochemical markers, particularly the cardiac troponins, are the best criterion to detect the presence of small myocardial cell damage. Myoglobin allows early diagnosis, whereas troponins are more specific for myocardial injury.Noninvasive cardiac imaging probing contractile reserve, myocardial perfusion, and metabolism is now available for detecting and monitoring ischemia. Although echocardiography and nuclear medicine have the most solid record in the clinical setting, magnetic resonance imaging offers flexibility to evaluate several parameters of myocardial ischemia in one single study.