Document Detail


The coronary circulation in human septic shock.
MedLine Citation:
PMID:  3948366     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Reversible myocardial depression, manifested by ventricular dilatation and decreased ejection fraction, is common in human septic shock. A proposed mechanism, based on animal studies, is myocardial ischemia resulting from inadequate coronary blood flow. Coronary flow observations have not been reported for human septic shock. To determine whether myocardial depression in human septic shock is associated with reduced coronary flow, thermodilution coronary sinus catheters were placed in seven patients with septic shock for measurements of coronary flow and myocardial metabolism. Four of the seven patients developed myocardial depression. These patients had coronary flow similar to or higher than that of control subjects and similar to that of the other three patients, who did not develop myocardial depression. None of the patients had net myocardial lactate production. In general, compared with values in control subjects, the oxygen content difference (arterial minus coronary sinus) was narrowed, and the fractional extraction of arterial oxygen was diminished. This pattern of disordered coronary autoregulation is analogous to the pattern of arteriovenous shunting in other organs in patients with septic shock. The preservation of coronary flow, the net myocardial lactate extraction, and the increased availability of oxygen to the myocardium argue against global ischemia as the cause of myocardial depression in human septic shock.
Authors:
R E Cunnion; G L Schaer; M M Parker; C Natanson; J E Parrillo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  73     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1986 Apr 
Date Detail:
Created Date:  1986-04-23     Completed Date:  1986-04-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  637-44     Citation Subset:  AIM; IM; X    
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MeSH Terms
Descriptor/Qualifier:
Acquired Immunodeficiency Syndrome / metabolism,  physiopathology
Adolescent
Adult
Aged
Anemia, Aplastic / metabolism,  physiopathology
Coronary Circulation*
Humans
Lactates / blood
Male
Middle Aged
Neoplasms / metabolism,  physiopathology
Oxygen Consumption
Regional Blood Flow
Shock, Septic / physiopathology*
Chemical
Reg. No./Substance:
0/Lactates

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


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