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Cardiovascular

Response in Sepsis
Purwoko
Consultant of Cardiovascular Anesthesia
Medical Faculty UNS/Moewardi General Hospital
Surakarta
2015
Introduction

SEPSIS IS THE MOST COMMON


CAUSE OF DEATH IN ICU !!!
MODS
SEPSIS and the HEART
Common Findings :
Structural Changes
Interstitial
Cardiac Dysfunction in Sepsis Proposed Mechanism (Merx 2007)
Cardiomyocytes Hypoxia
Myocardial Depressant Substance

NO overproduction peroxynitrite
Lysozyme c
Pro-inflammatory cytokines TNF-,
IL-1 and IL-6 cAMP
Prostanoids
Nitric oxide (NO)
Sepsis
Vascular Changes in Sepsis
V
Endothelial cells
Sepsis
iNOS
NO Hypotension
Hyperpermeability
Hyperpermeability

Lee 2010
Glyocalyx
Thin layer on the endothelial
surface
Composed of lycosaminoglycans
and Proteoglycans
Glycocalyx
Function :
Gatekeeping
Endothel Barrier Permeability
Mechanotranducer
glycocalyx Endothel NO vascular
tone
Microenviroment control
Coagulation
Endothel proliferation
Leucocyte adherence
Gylcocalyx in Sepsis
TNF
Glycocalyx
Vascular permeability
Coagulopathy in Sepsis

Hunt 2014
Conclusions
Sepsis is one of the leading cause of death in
icu
Common findings in cardiac dysfuntion :
Systolic and diastolic impairment, Increased
Troponin I-T level, Infiltration of macrophage
into cardiomyocytes
Vascular changes in sepsis includes : increased
permeability, coagulopathy, impaired
anticoagulation mechanism, and NO imbalance
Thank You