PIP: This literature review selects basic science and clinical papers that discuss the pathophysiology and therapy of cardiogenic shock. Cardiogenic shock results from decreased coronary blood flow. This decreased flow lowers the tension of myocardial oxygen and raises the concentration of myocardial depressant metabolites, reducing contractile strength and cardiac output. When presented with cardiogenic shock, an effort should be made to raise oxygen tension and decrease metabolite concentration. This can be done by improving coronary blood flow, but other routes to the same ends include restoration of normal arterial oxygen use and metabolite production. If oxygenation proves insufficient, an agent must be used which directly stimulates myocardial strength, it is important to choose a drug that does not further aggravate the already disproportionate difference between oxygen delivery and use. (Digitalis is the agent of choice, followed by metaraminol and levarterenol; isoproterenol should not be used.) An increase in strength at the expense of a further reduction in myocardial oxygen tension and a further increase in the concentration of myocardial depressant metabolites can only lead to a decreased chance of survival.