Myocardial dysfunction is commonly encountered in humans, and presumably in dogs with sepsis and critical illness. This dysfunction contributes to increased mortality. With management of the underlying diseases and an understanding of the processes contributing to myocardial dysfunction, steps may be taken to mitigate the consequences of cardiac impairment. Clinical findings, proposed pathophysiologic mechanisms, and current treatment considerations are discussed. Further study is needed to find practical ways to identify myocardial dysfunction and to determine whether timed interventions intended to augment cardiac performance will reduce mortality in this patient population.