Résumé
La dysfonction myocardique au cours du sepsis est une entité largement reconnue. Classiquement, elle débute dans les vingt-quatre heures ou dans les premiers jours du début du sepsis et se caractérise par une dépression de la fonction systolique (diminution de la fraction d’éjection) et une dilatation biventriculaire, surtout en cas d’apports liquidiens importants. Chez les survivants, la dépression myocardique évolue vers un retour à la normale au bout de cinq à sept jours. Au cours des dix à quinze dernières années, la généralisation de l’échocardiographie en réanimation a permis d’observer qu’en réalité, son expression clinique est très variable d’un sujet à l’autre et d’un moment à l’autre de l’évolution du choc septique. De ce fait, il semble plus approprié de parler de dysfonction que de dépression myocardique au cours du sepsis. D’un point de vue physiopathologique, il est probable que cette variabilité clinique traduise l’implication ou la prédominance de mécanismes différents. De très nombreux mécanismes potentiels ont en effet été démontrés. à l’extrême, en se fondant sur les travaux expérimentaux, on peut considérer que la totalité des voies de régulation des fonctions du cardiomyocyte sont altérées au cours du choc septique. De grandes incertitudes demeurent en fait sur le rôle réel de chacun des mécanismes proposés dans la littérature. On peut néanmoins distinguer des mécanismes extrinsèques aux myocytes cardiaques (surtout plasmatiques et/ ou endothéliaux), à effet souvent immédiat, et d’autres purement intramyocytaires, à effet volontiers plus retardé.
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Réfénces
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Tavernier, B., Rabuel, C., Mebazaa, A. (2011). Physiopathologie de la défaillance cardiaque. In: Sepsis grave et choc septique. Le point sur …. Springer, Paris. https://doi.org/10.1007/978-2-8178-0064-6_3
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