Sepsis is a complex syndrome with heterogeneous clinical presentation and outcome, characterized by an abnormal inflammatory response as central pathophysiological process potentially leading to multiorgan damage and hemodynamic instability. Early resuscitation with fluids and the timely control of the source of sepsis are key treatment targets in septic patients. Recommendations on time to treat with vasopressors and inotropes are mostly empirical and anecdotal, remaining therefore a topic of debate.This narrative review has been developed proposing cases to present and discuss typical pathophysiologic problems in the early management of hemodynamic derangement induced by sepsis. We will present the latest findings about the treatments currently used for hemodynamic support in patients with septic shock and their relationship with sepsis-related myocardial dysfunction and outcome.