Low cardiac output syndrome (LCOS) is a multifaceted syndrome of inadequate tissue perfusion and is clinically defined as a CI less than 2,0 L/min/m2. Criterion of CI greater than 2,0 L/min/m2 is generally accepted as the minimal requirement for effective perfusion of the microcirculation. LCOS is associated with an increased risk of cardiac death and higher probability of postoperative complications (respiratory failure, renal insufficiency, neurological sequel). Prompt diagnosis and intervention are essential for this potentially life -threatening condition. Clinical features and sequence of hemodynamic changes with evolving ventricular dysfunction are: ­PCWP®ŻSV and ­HR®ŻCO and ­SVR®ŻBP with cool, clammy skin, slow capillary refill, oliguria (<0.5 ml/kg/h); restlessnes, agitation, depressed mental status, tachypnea, reduced mixed SvO2 (<65%-70%), metabolic acidosis. For anesthesiologist, postoperative causes of LCOS are important (hypovolemia, eleveted SVR, myocardial dysfunction, cardiac tamponade, dysrhythmia, increased intrathoracic pressure). Management of LCOS is the best achieved by systematic and physiologic approach to the optimisation of the determinants of CO. (HR and arrhythmias preload, afterload, and contractility with vasodilator therapy and inotropic therapy or mechanical assist devices (IABP, VADs, ECMO, CPB-portable system).