THE HEART IN SEPSIS AND MODS

Dysfunctioning of the heart forms part of the multiple organ dysfuncti on syndrome (MODS) in sepsis and SIRS. This acute septic cardiomyopath y is often underestimated in degree and relevance, although yet in fac t 10% of all sepsis fatalities are due to intractable heart failure. T his potentially reversible cardiomyopathy is characterized by a consid erable pump failure, is not primarily ischemic, coronary blood flow be ing normal or even enhanced; left and right ventricle are enlarged as a consequence of an increased ventricular compliance. Damage of the he art can further be aggravated in case of an additional right ventricul ar impairment due to pulmonary hypertension in ARDS. SIRS-cardiomyopat hy in noninfectious MODS has common traits with acute septic cardiomyo pathy. The pathogenesis of heart disease in sepsis and SIRS is multifa ctorial, the ''endotoxin/TNF-alpha/NO/cGMP-cascade representing a main negative inotropic axis. Therapy of acute septic cardiomyopathy and S IRS-cardiomyopathy at present still is mainly symptomatic (volume subs titution, inotropic/vasoactive agents), causal therapeutic principles are, however, put to test in the context of a comprehensive concept of causal sepsis treatment.