By Jon-Emile S. Kenny [@heart_lung] “I want to be your medicine, I want to feed the sparrow in your heart …” -Kristian Matsson Case A 39 year old woman is admitted to the intensive care unit for hypotension, anuria and altered mentation despite 3 litres of intravenous lactated ringers infusion. She is febrile and found to have gram negative bacteremia of a urinary source. Her lactate remains 4.3 mmol/L with a mean arterial pressure of 63 mmHg whilst on norepinephrine and vasopressin infusions. Her urine output remains low and a bedside echocardiogram by the critical care fellow reveals a depressed ejection fraction. The possibility of levosimendan is raised on evening rounds.