Document Detail

Coronary hemodynamics and myocardial metabolism of lactate, free fatty acids, glucose, and ketones in patients with septic shock.
MedLine Citation:
PMID:  3815765     Owner:  NLM     Status:  MEDLINE    
To investigate disturbances in the coronary circulation and myocardial metabolism during septic shock, we examined coronary sinus blood flow and myocardial substrate extraction in 40 patients with septic shock and 13 control patients. Patients with coronary artery disease were excluded from this study. The global hemodynamic pattern of the septic patients was characterized by a lower stroke volume, despite an elevated cardiac index. Coronary sinus blood flow was high (187 +/- 47 vs 130 +/- 21 ml/min in the control group, p less than .001) due to marked coronary vasodilation, especially in the subgroup of nonsurvivors. In contrast to the control group, myocardial lactate uptake was elevated, while that of free fatty acids, glucose, and ketone bodies was diminished in patients with septic shock. These findings were especially prominent in the nonsurvivors. Expressed as oxygen equivalents, the contribution of free fatty acids as an energy source of the myocardium was markedly diminished in septic patients (12% vs 54% in the control group, p less than .005), while that of lactate was increased (36% vs 12%, p less than .01). The observed shift in myocardial substrate extraction was associated with a discrepancy between measured myocardial oxygen consumption and that calculated chemically from commonly available exogenous substrates: 41% of myocardial oxygen consumption was not explained by the utilization of commonly available substrates extracted from coronary circulation in all patients with septic shock.(ABSTRACT TRUNCATED AT 250 WORDS)
J F Dhainaut; M F Huyghebaert; J F Monsallier; G Lefevre; J Dall'Ava-Santucci; F Brunet; D Villemant; A Carli; D Raichvarg
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  75     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1987 Mar 
Date Detail:
Created Date:  1987-04-06     Completed Date:  1987-04-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  533-41     Citation Subset:  AIM; IM    
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MeSH Terms
Coronary Circulation*
Energy Metabolism
Fatty Acids, Nonesterified / metabolism*
Glucose / metabolism*
Ketone Bodies / metabolism*
Lactates / metabolism*
Lactic Acid
Middle Aged
Myocardium / metabolism*
Oxygen Consumption
Shock, Septic / physiopathology*
Reg. No./Substance:
0/Fatty Acids, Nonesterified; 0/Ketone Bodies; 0/Lactates; 50-21-5/Lactic Acid; 50-99-7/Glucose

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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