Few presentations to the emergency department are as critical or dramatic as the patient in shock. Cardiovascular disasters that commonly present with shock include massive pulmonary embolism, cardiac tamponade, aortic dissection and aneurysm, and cardiogenic shock associated with acute myocardial infarction. Because patients in "cardiovascular shock" have similar clinical presentations and a high degree of morbidity and mortality, they demand rapid, efficient, and aggressive evaluation and treatment. This article reviews the evaluation and treatment of patients presenting with cardiovascular shock.