Published online Aug 16, 2015. doi: 10.12998/wjcc.v3.i8.743
Peer-review started: August 25, 2014
First decision: November 27, 2014
Revised: May 26, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: August 16, 2015
A 59-year-old nursing home patient with Down syndrome was brought to the internal medicine department of our hospital due to fever, cough without expectorate, and dyspnea. A thoracic computed tomography revealed the presence of bilateral basal parenchymal opacities. Her condition deteriorated after admission and troponin reached a peak serum concentration of 16.9 ng/mL. The patient was in cardiogenic shock. In addition to fluid resuscitation, vaso-active amine infusion was administered to achieve hemodynamic stabilization. The differential diagnosis investigated possible pulmonary embolism, myocardial infarction, and myocarditis. Furthermore, a second transthoracic echocardiogram suggested Tako-Tsubo syndrome. This is a septic patient. The purpose of this manuscript is to review studies which formerly examined the possible association between high levels of troponin and mortality to see if it can be considered a positive predictive factor of fatal prognosis as the case of thrombocytopenia, already a positive independent predictive factor of multiple organ failure syndrome, and generally to characterize risk profile in a septic patient.
Core tip: The importance of cardiac involvement during sepsis, when occurs, worsens prognosis. However, as myocardial dysfunction is reversible, an early diagnosis and treatment to improve the survival. The awareness of risk profile to develop a severe myocardial dysfunction in a septic patient would be suitable in order to enforce careful resources in this subset of patients. Moreover, other research are needful to perform the best therapeutic strategy of haemodynamic stay which, sometimes, (e.g., when Tako-Tsubo syndrome occurs) can call for intra-aortic balloon pump counter pulsation.