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Septic Cardiomyopathy — FRCA Final MCQ

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ModerateIntensive Care MedicineSeptic CardiomyopathyFRCA Final

A 55-year-old man (ASA III) in ICU with septic shock has a noradrenaline requirement of 0.5 mcg/kg/min and a new echocardiogram showing a dilated, poorly contracting left ventricle with an EF of 25% and elevated filling pressures. This was previously normal. What is the diagnosis?

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Correct answer: C — Septic cardiomyopathy (sepsis-induced myocardial dysfunction)

Septic cardiomyopathy (sepsis-induced myocardial dysfunction) occurs in approximately 40-60% of patients with septic shock. It presents with new biventricular dysfunction (reduced EF, ventricular dilation) on echocardiography in the context of sepsis. It is typically reversible (recovery within 7-14 days in survivors). Management: optimise volume status, add dobutamine or levosimendan for inotropic support (not further vasopressors), and treat the underlying sepsis. Troponin may be mildly elevated. It differs from MI by the global (not regional) nature of dysfunction.

Reference: SSC – 2021 – International guidelines; ICS – 2023 – Sepsis haemodynamic management