Sepsis remains the most common admission diagnosis to ICU, and approximately half of these patients develop some form of cardiovascular dysfunction. Genetic factors, large vessel and microcirculatory changes, depressant factors, metabolic changes, autonomic dysregulation and many cellular regulators have all been implicated in the myocardial dysfunction. Septic cardiomyopathy can be classified as a secondary form of cardiomyopathy, and its pathophysiology is much more complex than the pathophysiology of other heart diseases. Cardiac dysfunction is characterized by systolic, as well as diastolic dysfunction of the left and the right ventricle, reversible dilatation of the heart, chronotropic and bathmotropic dysregulation, and reduced heart rate variability. Current approaches to treatment include guidelines of sepsis and septic shock therapy, with vasopressor, inotropic therapy and occasionally cardiac mechanical support.