• Urina JassirDanielaDDepartment of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, La., Antoine H Chaanine, Sapna Desai, Indranee Rajapreyar, and Thierry H Le Jemtel.
• Department of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, La.
• Am. J. Med. 2023 Jan 1; 136 (1): 273227-32.

AbstractSepsis is an increasing cause of decompensation in patients with chronic heart failure with reduced or preserved ejection fraction. Sepsis and decompensated heart failure results in a mixed septic-cardiogenic shock that poses several therapeutic dilemmas: Rapid fluid resuscitation is the cornerstone of sepsis management, while loop diuretics are the main stay of decompensated heart failure treatment. Whether inotropic therapy with dobutamine or inodilators improves microvascular alterations remains unsettled in sepsis. When to resume loop diuretic therapy in patients with sepsis and decompensated heart failure is unclear. In the absence of relevant guidelines, we review vasopressor therapy, the timing and volume of fluid resuscitation, and the need for inotropic therapy in patients who, with sepsis and decompensated heart failure, present with a mixed septic-cardiogenic shock.Copyright © 2022 Elsevier Inc. All rights reserved.

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