Inside myocardial dysfunction in septic shock

Two related mechanisms occur as sepsis progresses to septic shock: intravascular refractory hypovolemia due to vascular endothelium dysfunction and, in more severe cases, primitive heart failure and contractility reduction. Whereas the role of vascular endothelium has been well recognized, different events, such as global ischemia, myocardial inflammation and biochemical toxicity, have been hypothesized as underlying causes of myocardial dysfunction. However, in current clinical practice the real mechanisms leading to heart failure and contractility impairment in patients with septic shock remain uncertain. Cardiac magnetic resonance (CMR), because of its capability to characterize myocardial tissue 'in vivo' can discriminate between ischemic and inflammatory injuries, allowing the more appropriate therapeutic strategy. The case presented herein highlights the usefulness of CMR in this subset of patients.