Recent events have brought attention to the potential of Bacillus anthracis as an agent of bioterrorism. The shock like state of anthrax is invariably associated with high mortality, despite anti-microbial and supportive therapy. Multi-system dysfunction is typical, including: enhanced vascular permeability, hemorrhage and inflammation. Important questions concerning the pathophysiology of anthrax-associated shock remain unanswered, including the effects of B. anthracis infection on cardiac function. This review discusses the current state of knowledge regarding the pathophysiology of anthrax-associated shock.