Septic shock is often described as a distributive form of shock characterized by vasodilation and microcirculatory dysfunction. While these features are certainly important, they can distract from another common manifestation of severe sepsis: myocardial dysfunction.
Septic myocardial dysfunction, sometimes referred to as septic cardiomyopathy, occurs in a substantial proportion of patients with septic shock. Unlike ischemic cardiomyopathy, the primary problem is not coronary occlusion.
Instead, a complex interaction of inflammatory mediators, mitochondrial dysfunction, calcium handling abnormalities, and autonomic dysregulation contributes to impaired myocardial performance.
One of the most interesting aspects of septic myocardial dysfunction is that cardiac output may remain normal or even elevated despite significant impairment in intrinsic contractility. Reduced systemic vascular resistance lowers afterload, allowing the ventricle to maintain stroke volume despite depressed myocardial function.