Reversible segmental myocardial dysfunction in septic shock

Rapidly progressive and overwhelming meningococcal septicaemia in a 14 year old girl

“…Myocardial dysfunction in the presence of septic shock has also been described by Carmona et al 8 . Thomas et al have reported echocardiographic changes consistent with acute myocardial infarction in two patients who at autopsy were found to have no evidence of coronary arterial disease 9 . Endogenous opioids, in particular pituitary derived beta endorphin, also exert a cardiodepressant effect, possibly vagally mediated 10,11 .…”

“…The haemoglobin concentration was 154g/L. The white cell count was 5.5 × 10 9 /L, with 74.3% neutrophils and moderate toxic granulation, and intracellular gram negative diplococci were present. There was a marked thrombocytopenia with a platelet count of 48 × 10 9 /L (normal range 140–400).…”

“…The white cell count was 5.5 × 10 9 /L, with 74.3% neutrophils and moderate toxic granulation, and intracellular gram negative diplococci were present. There was a marked thrombocytopenia with a platelet count of 48 × 10 9 /L (normal range 140–400). Plasma electrolytes were normal but urea and creatinine were elevated at 9.4mmol/L (2.5–7.0) and 0.28mmol/L (0.05–0.12) respectively.…”

L’échocardiographie transthoracique et transœsophagienne

“…Elle est rarement au premier plan et peut alors être responsable d'un authentique choc cardiogénique qui nécessite une prise en charge spécifique (22)(23)(24). La dysfonction cardiaque est le plus souvent globale mais peut se présenter comme une atteinte segmentaire (25), elle peut intéresser la fonction systolique et diastolique des deux ventricules et se démas-quer ou s'aggraver au cours de l'évolution du sepsis (26)(27)(28). L'échographie est donc un outil de surveillance très utile en contexte de choc septique (29).…”