If a patient with sepsis develops heart failure and does not receive timely treatment, the outcome can be devastating
BY ASSOC PROF DR TAN TOH LEONG
AND DR JAY REUBEN SAVARIMUTHU
Sepsis is a medical emergency. One of the feared complications of sepsis is heart failure.
If a patient with sepsis develops heart failure and does not receive treatment in a timely manner, the outcome can be devastating. According to an article published in the Journal of American Heart Association in 2018, sepsis accounts for one quarter of deaths due to heart failure.
Sepsis can cause heart failure in patients with no pre-existing heart condition and can worsen heart function in patients with heart disease or heart failure.
There are various ways sepsis can cause heart failure. Sepsis can also affect various structures of the heart such as:
i. Trigger a heart attack. A blockage of the blood flow to the heart can be seen in sepsis patients. Sepsis can cause inflammation of the blood vessel to the heart, resulting in a heart attack.
ii. Inflammation to the layers of the heart can affect the heart’s pumping ability and patients can progress rapidly to heart failure.
iii. Valves of the heart can be damaged and cause ineffective blood flow to the rest of the body.
iv. Rhythm of your heart can be disturbed and caused a condition called Atrial Fibrillation.
Patients with heart failure often have Sepsis Induced Cardiomyopathy (SIC). It is a type of heart disease and is one of the main predictors of death in sepsis with a mortality rate of 70 per cent. If treatment is given early, these changes can be reversed within seven to 10 days. However, treatment can be very challenging in patients who have developed SIC.
Detecting heart failure
There are symptoms that can indicate if you have heart disease in sepsis. If you experience chest pain, difficulty in breathing, sweat profusely or have palpitations (awareness of ones’ heartbeat), please seek immediate treatment.
There are various ways a doctor can diagnosed SIC or heart failure in their practice.
A common bedside tool that is used is ECG (Electrocardiography). If you develop a heart attack or having an abnormal heart rhythm due to sepsis, an ECG would be able to detect it.
A very specific blood investigation for the heart called troponin can be obtained from the patient. If the troponin level is above the cut off value, the patient could be having a heart attack. The BNP (brain natriuretic peptide) level can be raised in your blood if you heart is under stress due to sepsis.
A more detailed approach using technology can be adopted at the hospital. An echocardiography can see all the four chambers of the heart and assess heart function.
Doctors will be able to know if your heart is pumping effectively or if the chambers of the heart are enlarged. By having this information, specific drugs can be given to optimise a patient’s heart function.
“A one size fits all” approach can’t be used for all patients in sepsis with heart failure. Research is still ongoing on the various treatment for heart failure. A strategy called cardioprotective strategy that suppress the heart function can be adopted in certain cases. However, this treatment remains controversial till today.
If your loved ones are having an infection, ask yourself this question. Could it be sepsis? This could save their life. – The Health