Septic Cardiomyopathy

Septic cardiomyopathy is a transient, reversible myocardial dysfunction that complicates pediatric sepsis and septic shock. It is characterized by reduced ejection fraction, ventricular dilation, and impaired contractility, often contributing to hemodynamic instability. Although well-described in adults, pediatric-specific data are limited, and clinical recognition remains challenging. The incidence of septic cardiomyopathy in pediatric sepsis is reported between ۲۵-۵۰%. Pathophysiology involves inflammatory cytokines, nitric oxide overproduction, mitochondrial injury, and microvascular dysfunction. Echocardiography remains the primary diagnostic tool, revealing global systolic impairment, sometimes with preserved stroke volume due to reduced afterload. Biomarkers such as troponin and BNP provide supportive evidence but lack specificity. Management strategies include targeted use of inotropes (dobutamine, milrinone), avoidance of excessive catecholamine stimulation, and mechanical circulatory support (ECMO) in refractory cases. Most children demonstrate recovery of ventricular function within ۷-۱۰ days if infection is controlled and optimal hemodynamic support is provided. Future pediatric-specific research is needed to refine treatment algorithms, evaluate the role of newer agents (e.g., beta-blockade, mitochondrial stabilizers), and define indications for mechanical support.