Fig. 2

Direct myocardial depression in sepsis. A major mechanism of direct cardiac depression in sepsis is cardiomyocyte hyporesponsiveness due to down-regulation of β-adrenergic receptors and depression of post-receptor signaling pathways. These changes seem to be mediated by many substances, including cytokines and nitric oxide. Another mechanism of direct cardiac depression is cardiomyocyte injury or death, which can be induced by toxins, complements, damage-associated molecular patterns (DAMPs), neutrophil extracellular traps (NETs), and as-yet-unidentified myocardial depressant factors (MDFs). MOF multiple organ failure, PAMPs pathogen-associated molecular patterns, PRRs pattern recognition receptors