Physical differences between male and female patients largely do not affect their management in the cardiac intensive care unit except relating to physical size. Other than basic critical care considerations regarding airway and ventilatory management (endotracheal tube/tracheostomy size, ideal body weight tidal volumes) and drug dosage, there is little that is not encompassed in general critical care management, however some areas warrant specific consideration. First, women who meet nutritional goals have a lower hazard ratio of dying on the intensive care compared with men, but this benefit is lost if they meet their energy target but fail to reach their protein target (possibly due to the smaller total protein stores in women). Second, the anatomical and physiological differences between genders (including body weight, composition, GI motility, liver metabolism and glomerular filtration rate) significantly alter pharmacokinetics and dynamics of drugs, including absorption, distribution, metabolism and elimination. Women are more susceptible to the effects of neuromuscular blockade, opioid receptor agonists, and beta adrenergic agents, as well as having a variable but attenuated response to pressor agents under conditions of stress. The potential response to beta adrenergic agents on cardiovascular function should also be carefully considered prior to institution of therapy. In particular, elderly female patients with basal septal hypertrophy may respond to dobutamine by developing worsening abnormalities of diastolic dysfunction and significantly increasing left-ventricular outflow tract obstruction. The condition should be suspected in case of deteriorating cardiac output in the presence of escalating inotropic support, and is readily confirmed using echocardiography. Treatment comprises cessation of beta adrenergic agents, volume and pressor resuscitation, and timely re-introduction of beta blocking agents (where right ventricular function allows).