[Cardiogenic shock] most commonly results from large myocardial infarctions (MIs; >40% of left ventricle) leading to pump failure. Mechanical complications of MI, including right ventricular dysfunction, acute mitral regurgitation, septal rupture, and free-wall rupture, can also lead to cardiogenic shock. In patients with mechanical complications, urgent surgical repair is needed. Other cardiac causes of cardiogenic hypotension include pericardial tamponade, severe obstructive valvular heart disease, and progression of a chronic cardiomyopathy. Urgent echocardiography is particularly helpful in delineating the causes of cardiogenic shock.