Abstract
Heart rate is measured in every critically ill patient and high values often reflect the severity of underlying disease. Nevertheless, in clinical practice the pathophysiological implications of an increase in heart rate are often undervalued. The importance of elevated heart rate and its role in determining or contributing to cardiovascular diseases began to be recognized at the end of the 1970s. Nowadays, it is clear that tachycardia represents an independent risk factor for mortality and morbidity in several clinical conditions, including coronary artery disease, myocardial infarction, and congestive heart failure [1–7]. Furthermore, it has also been demonstrated that with respect to other cardiovascular factors, a high heart rate is the best predictor of mortality in different categories of patients [6]. Results of numerous large epidemiological trials confirm that an elevated heart rate not only represents a clinical sign of altered cardiac function but also contributes to cardiac dysfunction. Although the role of an elevated heart rate is well established and has clearly been linked to outcome in cardiology patients, the topic has gained less attention in septic patients. To date only a few small clinical studies have evaluated the relationship between increased heart rate and mortality in patients suffering from septic shock. However, the results of such studies strongly suggest that elevated heart rate is a risk factor for increased mortality, even in septic shock patients [8–10]. A reduction in heart rate could, therefore, improve outcomes for septic shock patients by lowering cardiac workload and improving diastolic coronary perfusion of the septic heart. Recently, the results from a monocenter trial that investigated the hemodynamic effects of reducing heart rate with the β-blocker esmolol in septic shock patients attracted the interest of critical care physicians [10]. The aim of this article is to provide an overview of the pathophysiology of sepsis-induced tachycardia and its implications in the clinical management of affected patients.
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Copie X, Hnatkova K, Staunton A, Fei L, Camm AJ, Malik M (1996) Predictive power of increased heart rate versus depressed left ventricular ejection fraction and heart rate variability for risk stratification after myocardial infarction. Results of a two-year follow-up study. J Am Coll Cardiol 27:270–276
Dyer AR, Persky V, Stamler J et al (1980) Heart rate is a prognostic factor for coronary heart disease and mortality: findings in three Chicago epidemiologic studies. Am J Epidemiol 112:736–749
Diaz A, Bourassa MG, Guertin MC, Tardif JC (2005) Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease. Eur Heart J 26:967–974
Disegni E, Goldbourt U, Reicher-Reiss H et al (1995) The predictive value of admission heart rate on mortality in patients with acute myocardial infarction. SPRINT study group. Secondary Prevention, Reinfarction, Israeli Nifedipine Trial. J Clin Epidemol 48:1197–1205
Sander O, Welters ID, Foëx P, Sear JW (2005) Impact of prolonged elevated heart rate on incidence of major cardiac events in critically ill patients with a high risk of cardiac complications. Crit Care Med 33:81–88
Singh BN (2003) Increased heart rate as a risk factor for cardiovascular disease. Eur Heart J Suppl 5(Suppl G):G3–G9
Kannel WB, Kannel C, Paffenberger RS Jr, Cupples LA (1987) Heart rate and cardiovascular mortality: the Framingham study. Am Heart J 113:1489–1494
Azimi G, Vincent JL (1986) Ultimate survival from septic shock. Resuscitation 14:245–253
Parker MM, Shelhamer JH, Natanson C, Alling DW, Parrillo JE (1987) Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis. Crit Care Med 15:923–929
Morelli A, Ertmer C, Westphal M et al (2013) Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial. JAMA 310:1683–1691
Leibovici L, Gafter-Gvili A, Paul M et al (2007) Relative tachycardia in patients with sepsis: an independent risk factor for mortality. QJM 100:629–634
Schmittinger CA, Torgersen C, Luckner G, Schröder DC, Lorenz I, Dünser MW (2012) Adverse cardiac events during catecholamine vasopressor therapy: a prospective observational study. Intensive Care Med 38:950–958
Bhagat K, Hingorani AD, Palacios M, Charles IG, Vallance P (1999) Cytokine-induced venodilatation in humans in vivo: eNOS masquerading as iNOS. Cardiovasc Res 41:754–764
Marx G, Vangerow B, Burczyk C et al (2000) Evaluation of noninvasive determinants for capillary leakage syndrome in septic shock patients. Intensive Care Med 26:1252–1258
Parillo JE (1993) Pathogenetic mechanisms of septic shock. N Engl J Med 328:1471–1477
Dellinger RP, Levy MM, Rhodes A (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41:580–637
Dünser MW, Hasibeder WR (2009) Sympathetic overstimulation during critical illness: adverse effects of adrenergic stress. J Intensive Care Med 24:293–316
Rudiger A, Singer M (2013) The heart in sepsis. Curr Vasc Pharmacol 11:187–195
Schmidt H, Muller-Werdan U, Hoffmann T et al (2005) Autonomic dysfunction predicts mortality in patients with multiple organ dysfunction syndrome of different age groups. Crit Care Med 33:1994–2002
Sharshar T, Gray F, de la Lorin Grandmaison G et al (2003) Apoptosis of neurons in cardiovascular autonomic centres triggered by inducible nitric oxide synthase after death from septic shock. Lancet 362:1799–1805
Magder SA (2012) The ups and downs of heart rate. Crit Care Med 40:239–245
Werdan K, Schmidt H, Ebelt H et al (2009) Impaired regulation of cardiac function in sepsis, SIRS, and MODS. Can J Physiol Pharmacol 87:266–274
Musialek P, Lei M, Brown HF, Paterson DJ, Casadei B (1997) Nitric oxide can increase heart rate by stimulating the hyperpolarization-activated inward current, I(f). Circ Res 81:60–68
Aoki Y, Hatakeyama N, Yamamoto S et al (2012) Role of ion channels in sepsis-induced atrial tachyarrhythmias in guinea pigs. Br J Pharmacol 166:390–400
Vieillard-Baron A, Caille V, Charron C, Belliard G, Page B, Jardin F (2008) Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med 36:1701–1706
Guarracino F, Baldassarri R, Pinsky MR (2013) Ventriculo-arterial decoupling in acutely altered hemodynamic states. Crit Care 17:213
Guarracino F, Ferro B, Morelli A, Bertini P, Baldassarri R, Pinsky MR (2014) Ventriculoarterial decoupling in human septic shock. Crit Care 18:R80
Notarius CF, Levy RD, Tully A et al (1998) Cardiac vs. non-cardiac limits to exercise following heart transplantation. Am Heart J 135:339–348
Joulin O, Marechaux S, Hassoun S, Montaigne D, Lancel S, Neviere R (2009) Cardiac force–frequency relationship and frequency-dependent acceleration of relaxation are impaired in LPS-treated rats. Crit Care 13:R14
Masutani S, Cheng HJ, Tachibana H, Little WC, Cheng CP (2011) Levosimendan restores the positive force-frequency relation in heart failure. Am J Physiol Heart Circ Physiol 301:H488–H496
Kern MJ (2000) Coronary physiology revisited: practical insights from the cardiac catheterization laboratory. Circulation 101:1344–1351
Grosse P, Clementy J (1995) Coronary reserve in experimental myocardial hypertrophy. Eur Heart J 16(Suppl 1):22–25
Marik PE (2006) Management of the critically ill geriatric patient. Crit Care Med 34:176–182
Balik M, Rulisek J, Leden P et al (2012) Concomitant use of beta-1 adrenoreceptor blocker and norepinephrine in patients with septic shock. Wien Klin Wochenschr 124:552–556
Morelli A, Donati A, Ertmer C et al (2013) Microvascular effects of heart rate control with esmolol in patients with septic shock: a pilot study. Crit Care Med 41:2162–2168
Schmittinger CA, Dünser MW, Haller M et al (2008) Combined milrinone and enteral metoprolol therapy in patients with septic myocardial depression. Crit Care 12:R99
Kumar A, Schupp E, Bunnell E, Ali A, Milcarek B, Parrillo JE (2008) Cardiovascular response to dobutamine stress predicts outcome in severe sepsis and septic shock. Crit Care 12:R35
Gore DC, Wolfe RR (2006) Hemodynamic and metabolic effects of selective beta1 adrenergic blockade during sepsis. Surgery 139:686–694
Volz-Zang C, Eckrich B, Jahn P, Schneidrowski B, Schulte B, Palm D (1994) Esmolol, an ultrashort acting selective beta 1-adrenoreceptor antagonist: pharmacodynamic and pharmacokinetic properties. Eur J Clin Pharmacol 46:399–404
Berk JL, Hagen JF, Beyer WH, Gerber MJ, Dochat GR (1969) The treatment of endotoxin shock by beta adrenergic blockade. Ann Surg 169:74–81
Morelli A, D’Egidio A, Orecchioni A, Marraffa E, Romano S (2014) Heart rate reduction with Esmolol in septic shock: effects on myocardial performance. Crit Care 18(Suppl 1):P162
Suzuki T, Morisaki H, Serita R et al (2005) Infusion of the beta-adrenergic blocker esmolol attenuates myocardial dysfunction in septic rats. Crit Care Med 33:2294–2301
Macchia A, Romero M, Comignani et al (2012) Previous prescription of β-blockers is associated with reduced mortality among patients hospitalized in intensive care units for sepsis. Crit Care Med 40:2768–2772
De Santis V, Frati G, Greco E, Tritapepe L (2014) Ivabradine: a preliminary observation for a new terapeutic role in patients with multiple organ dysfunction syndrome. Clin Res Cardiol 103:831–834
Fox KM, Ferrari R (2011) Heart rate: a forgotten link in coronary artery disease? Nat Rev Cardiol :369–379
Nuding S, Ebelt H, Hoke RS et al (2011) Reducing elevated heart rate in patients with multiple organ dysfunction syndrome by the If (funny channel current) inhibitor ivabradine. MODIfY Trial. Clin Res Cardiol 100:915–23
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Morelli, A., D’Egidio, A., Passariello, M. (2015). Tachycardia in Septic Shock: Pathophysiological Implications and Pharmacological Treatment. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2015. Annual Update in Intensive Care and Emergency Medicine 2015, vol 2015. Springer, Cham. https://doi.org/10.1007/978-3-319-13761-2_9
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DOI: https://doi.org/10.1007/978-3-319-13761-2_9
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