Frontiers in Myocardia

Volume: 1

Tachycardia and Its Pathophysiological Implications in Septic Myocardial Dysfunction

Author(s): Andrea Morelli and Maurizio Passariello

Pp: 176-187 (12)

DOI: 10.2174/9781681080604115010015

* (Excluding Mailing and Handling)

Abstract

Tachycardia is an independent risk factor for mortality and morbidity in different clinical conditions such as coronary artery disease, myocardial infarction, as well as congestive heart failure. Evidence suggests that an elevated heart rate is associated to increased mortality even in septic shock. It has been recently demonstrated that tachycardia persisting at 24 hours, after volume resuscitation and commencement of vasopressors, early identifies a particularly severe subset of septic shock patients. These high-risk patients would likely benefit most from HR control. A reduction in HR should be therefore considered as one of the therapeutic targets to improve patient outcome. Nevertheless, reducing HR in septic shock is difficult, because the right time for treatment and the optimal HR range are not currently defined. Based on the underlying mechanisms of elevated heart rate in septic shock, both beta blocker esmolol and hyperpolarization-activated cyclic nucleotide gated channel inhibitor ivabradine appear to be the most appropriate drugs for treating elevated HR. Nevertheless, the effectiveness and safety of these agents, the degree of HR reduction, as well as the appropriate target population, should be better defined before widely adopting this therapeutic strategy in the common clinical practice. The aim of this chapter is therefore to provide an overview of the underlying mechanisms of sepsis-induced tachycardia and their implications in the clinical management of affected patients.


Keywords: Adrenergic receptors, Beta-blockers, Ivabradine, Septic shock, Tachycardia.

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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59142107 and j.to_ip >=59142107 )) and ((j.from_date <= 1740420735 and j.to_date >= 1740420735 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 7804) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59142107 and j.to_ip >=59142107 )) and ((j.from_date <= 1740420735 and j.to_date >= 1740420735 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 7804) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59142107 and j.to_ip >=59142107 )) and ((j.from_date <= 1740420735 and j.to_date >= 1740420735 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 7804)
      600μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1734 and `b`.`banner_from_date` <= 1740420735 and `b`.`banner_to_date` >= 1740420735 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.07msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1734
      • 3: 1740420735
      • 4: 1740420735
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='79a94722aa55b9f64bbe16b8350716d0'
      240μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    5Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        v2ybQN3jTih4Nht3gQR62JyzdXOrPSE5KwSAFks0
        uc_cart_id
        79a94722aa55b9f64bbe16b8350716d0
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/7804" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/7804
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6ImRrZmlqa3MvbXZMM21vODRQVDhlS1E9PSIsInZhbHVlIjoidjdvaUxVNXpCNWZyN3RFREE2NWdwQ2R1VjR2TloxSWR3dmpUTEw4NDhPUT0iLCJtYWMiOiIyZmU5ZDU4MzQ4YTc3MmM5NTA4NGNiYjRjYmExYWVhNWEyNGJlYTcxNzQwZWE2ODJlOTUzODE3Y2VjZmNhYzUwIiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6ImRrZmlqa3MvbXZMM21vODRQVDhlS1E9PSIsInZhbHVlIjoidjdvaUxVNXpCNWZyN3RFREE2NWdwQ2R1VjR2TloxSWR3dmpUTEw4NDhPUT0iLCJtYWMiOiIyZmU5ZDU4MzQ4YTc3" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Mon, 24 Feb 2025 18:12:15 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IlJ0NnA2RVlkMTgwUTBzQUZQeTNQMXc9PSIsInZhbHVlIjoiSTMvNEtjeEpXbktmNUcrbU4vSHAxR01hakE1NFZmaFIyVFYxVmdFeGtSUnRSOGFDblZZSEFLeWttV2pYa3hQYnkxckd5Ym5zODBPUUxPR0trYVlpMVR2dGJTTHhaOXZ4MjZ1MHlUYTFyendFZS9EY1RJdUNZWDFhYWZ4ZVhrTSsiLCJtYWMiOiJiZDllYzk0ZTFiOWQxMDNkMmI0ZGRjNzFhYmI1MGMwZTFiOTlkYWQ0MDU1OTg2NWMzM2RiMzAwMDVhYjA1NTBhIiwidGFnIjoiIn0%3D; expires=Thu, 27 Feb 2025 06:12:15 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IlJ0NnA2RVlkMTgwUTBzQUZQeTNQMXc9PSIsInZhbHVlIjoiSTMvNEtjeEpXbktmNUcrbU4vSHAxR01hakE1NFZmaFIyVFYxVmdFeGtSUnRSOGFDblZZSEFLeWttV2pYa3hQYnkxckd5Y" 1 => "alphaeurekaselectnet_session=eyJpdiI6InlwSjhoak1OSnJ1bnd3S2tldjlRSHc9PSIsInZhbHVlIjoiVWxIb01XUVZieGdJWGdvWTBzSW1SY0szT3pZWi9qSURaaGpaMVl1NGg1UUlkdDZMZ1NsQW1RNTlxMGJiL3UwTDVZTStsdWNSM05QUDdCYjR5KzBXVm8yT2lja1F1Uzd0Q3gxUnduYVNLclN5ODJVbE5DRG5oSWQ3QmxtMnhHYlciLCJtYWMiOiI0YWEyOTcyNWRmYzlmMTgwMmYwOTdmMDU0ODAxZjExYTQ5NDViNjZkNGJlNzFjZDI5MWUxMDZkNTY0MTQ2NWI5IiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6InlwSjhoak1OSnJ1bnd3S2tldjlRSHc9PSIsInZhbHVlIjoiVWxIb01XUVZieGdJWGdvWTBzSW1SY0szT3pZWi9qSURaaGpaMVl1NGg1UUlkdDZMZ1NsQW1RNTl" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IlJ0NnA2RVlkMTgwUTBzQUZQeTNQMXc9PSIsInZhbHVlIjoiSTMvNEtjeEpXbktmNUcrbU4vSHAxR01hakE1NFZmaFIyVFYxVmdFeGtSUnRSOGFDblZZSEFLeWttV2pYa3hQYnkxckd5Ym5zODBPUUxPR0trYVlpMVR2dGJTTHhaOXZ4MjZ1MHlUYTFyendFZS9EY1RJdUNZWDFhYWZ4ZVhrTSsiLCJtYWMiOiJiZDllYzk0ZTFiOWQxMDNkMmI0ZGRjNzFhYmI1MGMwZTFiOTlkYWQ0MDU1OTg2NWMzM2RiMzAwMDVhYjA1NTBhIiwidGFnIjoiIn0%3D; expires=Thu, 27-Feb-2025 06:12:15 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IlJ0NnA2RVlkMTgwUTBzQUZQeTNQMXc9PSIsInZhbHVlIjoiSTMvNEtjeEpXbktmNUcrbU4vSHAxR01hakE1NFZmaFIyVFYxVmdFeGtSUnRSOGFDblZZSEFLeWttV2pYa3hQYnkxckd5Y" 1 => "alphaeurekaselectnet_session=eyJpdiI6InlwSjhoak1OSnJ1bnd3S2tldjlRSHc9PSIsInZhbHVlIjoiVWxIb01XUVZieGdJWGdvWTBzSW1SY0szT3pZWi9qSURaaGpaMVl1NGg1UUlkdDZMZ1NsQW1RNTlxMGJiL3UwTDVZTStsdWNSM05QUDdCYjR5KzBXVm8yT2lja1F1Uzd0Q3gxUnduYVNLclN5ODJVbE5DRG5oSWQ3QmxtMnhHYlciLCJtYWMiOiI0YWEyOTcyNWRmYzlmMTgwMmYwOTdmMDU0ODAxZjExYTQ5NDViNjZkNGJlNzFjZDI5MWUxMDZkNTY0MTQ2NWI5IiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6InlwSjhoak1OSnJ1bnd3S2tldjlRSHc9PSIsInZhbHVlIjoiVWxIb01XUVZieGdJWGdvWTBzSW1SY0szT3pZWi9qSURaaGpaMVl1NGg1UUlkdDZMZ1NsQW1RNTl" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "v2ybQN3jTih4Nht3gQR62JyzdXOrPSE5KwSAFks0" "uc_cart_id" => "79a94722aa55b9f64bbe16b8350716d0" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/7804" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-24 18:12:15GET/chapter/7804112197