Transient Sepsis-Induced Cardiomyopathy in the Setting of Alcohol Withdrawal

Sepsis-induced cardiomyopathy (SICM) is a reversible myocardial dysfunction that occurs in the setting of severe sepsis and septic shock, often complicating the management of patients with underlying cardiovascular disease. We report the case of a 62-year-old man with heart failure with improved ejection fraction (HFimpEF), paroxysmal atrial fibrillation, and severe alcohol use disorder who developed septic shock due to Enterococcus faecalis bacteremia, complicated by multiorgan failure and transient worsening of cardiac function. Myocardial dysfunction was attributed to SICM based on the temporal association with septic shock, elevated lactate and vasopressor requirement, new right ventricular dilation and hemodynamic compromise on transthoracic echocardiography, and subsequent recovery with sepsis resolution. Alternative etiologies were considered and excluded, including acute coronary syndrome, recurrent pulmonary embolism, and persistent tachycardia-mediated cardiomyopathy. Echocardiographic abnormalities emerged contemporaneously with bacteremia and shock onset and improved in parallel with hemodynamic stabilization and clearance of infection. Despite profound circulatory collapse, myocardial function recovered with supportive care, with clinical and echocardiographic improvement observed within days of shock resolution, reinforcing the reversible nature of SICM rather than alternative etiologies (e.g., acute coronary syndrome, recurrent pulmonary embolism, etc.). This case highlights the diagnostic challenges of SICM, particularly in patients with pre-existing heart failure and atrial fibrillation, and underscores its transient, reversible nature.