PT - JOURNAL ARTICLE AU - Tara L Jones AU - Kenta Nakamura AU - James M McCabe TI - Cardiogenic shock: evolving definitions and future directions in management AID - 10.1136/openhrt-2018-000960 DP - 2019 May 01 TA - Open Heart PG - e000960 VI - 6 IP - 1 4099 - http://openheart.bmj.com/content/6/1/e000960.short 4100 - http://openheart.bmj.com/content/6/1/e000960.full SO - Open Heart2019 May 01; 6 AB - Cardiogenic shock (CS) is a complex and highly morbid entity conceptualised as a vicious cycle of injury, cardiac and systemic decompensation, and further injury and decompensation. The pathophysiology of CS is incompletely understood but limited clinical trial experience suggests that early and robust support of the failing heart to allow for restoration of systemic homoeostasis appears critical for survival. We review the pathophysiology, clinical features and trial data to construct a contemporary model of CS as a systemic process characterised with maladaptive compensatory mechanisms requiring prompt and appropriately tailored medical and mechanical support for optimal outcomes. We conclude with an algorithmic approach to acute CS incorporating clinical and haemodynamic data to match the patient’s cardiac and systemic needs as a template for contemporary management.