Septic cardiomyopathy is frequently observed in patients with severe sepsis however it often does not require specific therapy. In patients presenting signs of tissue perfusion and inadequate cardiac output, manipulation of cardiac output should be considered. The first line therapies consist in optimization of preload by fluid administration and of afterload by decreasing the doses of vasopressor agents whenever possible. Inotropic agents should then be considered. Among these dobutamine remains the most commonly used, even though there is a huge individual variability in the response to it. The lowest dose associated with a satisfactory hemodynamic state should be used, as high doses for a prolonged period of time can be associated with impaired outcome. Phosphodiesterase inhibitors are often limited by their peripheral dilatory properties. Levosimendan is a promising inotropic agent, but its superiority to classical adrenergic inotropic agents remains to be determined.