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Many dogs with GDV are hypoperfused, resulting in generalized tissue ischemia. The hypoperfusion is multifactorial in origin, with the most important cause being obstruction to venous return as a result of occlusion of the caudal vena cava secondary to gastric tympany. Decreased right atrial filling results in decreased cardiac output. Some dogs will also have some degree of hypovolaemia as a result of hemorrhage or third spacing of fluid in the stomach. Cardiogenic shock may also occur as a result of arrhythmias and/or myocardial depression.

It is thought that the majority of postoperative systemic effects occur as a result of ischemia–reperfusion injury [24]. These include systemic inflammatory response syndrome (SIRS), hypotension, cardiac arrhythmias, disseminated intravascular coagulation (DIC), and acute kidney injury [25]. The presence of severe systemic effects is associated with a poorer prognosis [25].

Cardiac arrhythmias can occur in dogs with GDV. Most often these are ventricular in origin and are seen postoperatively (50–77% of dogs) but are also observed preoperatively in a lower proportion of dogs [7, 9]. The exact pathogenesis of these arrhythmias is unclear although alterations in coronary blood flow, circulating epinephrine and myocardial depressant factor have all been implicated [26].