Septic Shock and the Heart

  • Pietro BertiniEmail author
  • Fabio Guarracino
Critical Care Anesthesia (BS Rasmussen, Section Editor)
Part of the following topical collections:
  1. Critical Care Anesthesia


Purpose of Review

The aim of this review is to analyze the cardiovascular pathophysiology of septic shock. Using visual representations of a left ventricular cycle in the pressure/volume plane, we describe hemodynamic derangement occurring in septic shock and subsequent changes at each step of treatment allowing a rapid understanding of complex alterations.

Recent Findings

Acute circulatory failure during sepsis has to be counterbalanced rapidly and appropriately. The most recent guidelines rely on volume expansion, vasoactive, and inotropic support but underlining patients’ pathophysiology is often undetermined.


Diagnosis of the hemodynamic substrate needs to be carried out thoroughly, using echocardiography, now commonplace for the intensivist. A pathophysiological approach as we describe might help to understand complicated patterns allowing updates during resuscitation steps.

Finally, in our beliefs, clinicians should address septic shock resuscitation using a tailored approach and specific protocols, but their applicability needs to be investigated.


Pressure-volume loops Ventriculo-arterial coupling Sepsis Septic shock Hemodynamics Pathophysiology Critical care 



Mean arterial pressure


Volume expansion


Total peripheral resistance


Central venous pressure


Pulmonary artery occlusion pressure


Cardiac output


Mean systemic filling pressure


Mean systemic filling pressure analogue


Functional hemodynamic monitoring


Pulse pressure variation


Stroke volume variation


Dynamic elastance


Effective arterial elastance


Central venous oxygen saturation


Pressure-volume loop


Left ventricular elastance


End-systolic pressure-volume relationship


End-dyastolic pressure-volume relationship


Systolic blood pressure


End-systolic pressure


End-dyastolic pressure


End-dyastolic volume


Stroke volume


Ventriculo-arterial coupling


Heart rate


Myocardial oxygen consumption


Pressure-volume area


Stroke work


Potential energy


Right ventricular


Intra-aortic ballon pump


Extracorporeal membrane oxygenation


Veno-arterial (ECMO)


Veno-venous (ECMO)


Left ventricular assist device


Magnetic resonance imaging


Compliance With Ethical Standards

Conflict of Interest

Pietro Bertini and Fabio Guarracino declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Anaesthesia and Critical Care MedicineAzienda Ospedaliero Universitaria PisanaPisaItaly

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