Cardiogenic shock (CS) is a time-sensitive, hemodynamically complex syndrome with diverse etiologies and clinical presentations. Despite advances in treatment, CS remains associated with high morbidity and mortality, ranging from 35 to 50%. Recent observational research has highlighted the potential benefits of standardized, team-based care in improving outcomes. This review discusses the pathophysiology of CS, novel phenotypes, evolving definitions and staging systems, available pharmacologic and device-based therapies, standardized management protocols, and regionalized systems of care. It also explores opportunities for further research to address knowledge gaps. CS is the most common type of shock in patients admitted to the cardiac intensive care unit (CICU). Historically, CS was attributed to left ventricular (LV) dysfunction from acute myocardial infarction (AMI), but recent studies show that acute decompensation of chronic heart failure (HF) is the most common underlying cause. The prevalence of non-AMI CS has increased, partly due to reduced AMI incidence and improved survival in patients with significant irreversible ischemia. The pathophysiology of CS involves progressive impairment in ventricular contractility, leading to systemic hypoperfusion and multiorgan failure. Two main etiologies of CS are AMI-CS and HF-CS. AMI-CS is typically associated with injury to more than 40% of the LV myocardium, while HF-CS often presents with congestion in acute on chronic HF-CS phenotypes. The SCAI classification system, updated in 2022, includes five stages (A-E) to define CS severity based on biochemical, physical exam, and hemodynamic findings. The SCAI-CSWG classification provides specific thresholds for hypotension and hypoperfusion across all stages and incorporates variables such as treatment intensity and out-of-hospital cardiac arrest. Invasive hemodynamic assessment is useful in classifying CS. The Diamond-Forrester nomenclature initially proposed binary classification of HF patients based on perfusion and congestion, while modern classifications include distinct congestive profiles such as LV-dominant, RV-dominant, and biventricular (BiV) shock. AMI-CS is a significant challenge in health systems due to its multiorgan system ramifications. Early recognition and timely revascularization are critical for improving outcomes. The SHOCK trial demonstrated a 13% reduction in all-cause mortality in patients undergoing revascularization. The "golden hour" in CS management emphasizes prompt identification, revascularization, and admission to CICU. Emergency department care for CS requires prompt recognition by EMS and emergency department providers. Steps include early 12-lead ECG acquisition, administration of vasopressors, mechanical ventilation, point-of-care echocardiography, and immediate transfer to a primary PCI-capable facility. Transradial access is now the default for coronary angiography and PCI in patients with acute and chronic coronary syndromes. However, AMICardiogenic shock (CS) is a time-sensitive, hemodynamically complex syndrome with diverse etiologies and clinical presentations. Despite advances in treatment, CS remains associated with high morbidity and mortality, ranging from 35 to 50%. Recent observational research has highlighted the potential benefits of standardized, team-based care in improving outcomes. This review discusses the pathophysiology of CS, novel phenotypes, evolving definitions and staging systems, available pharmacologic and device-based therapies, standardized management protocols, and regionalized systems of care. It also explores opportunities for further research to address knowledge gaps. CS is the most common type of shock in patients admitted to the cardiac intensive care unit (CICU). Historically, CS was attributed to left ventricular (LV) dysfunction from acute myocardial infarction (AMI), but recent studies show that acute decompensation of chronic heart failure (HF) is the most common underlying cause. The prevalence of non-AMI CS has increased, partly due to reduced AMI incidence and improved survival in patients with significant irreversible ischemia. The pathophysiology of CS involves progressive impairment in ventricular contractility, leading to systemic hypoperfusion and multiorgan failure. Two main etiologies of CS are AMI-CS and HF-CS. AMI-CS is typically associated with injury to more than 40% of the LV myocardium, while HF-CS often presents with congestion in acute on chronic HF-CS phenotypes. The SCAI classification system, updated in 2022, includes five stages (A-E) to define CS severity based on biochemical, physical exam, and hemodynamic findings. The SCAI-CSWG classification provides specific thresholds for hypotension and hypoperfusion across all stages and incorporates variables such as treatment intensity and out-of-hospital cardiac arrest. Invasive hemodynamic assessment is useful in classifying CS. The Diamond-Forrester nomenclature initially proposed binary classification of HF patients based on perfusion and congestion, while modern classifications include distinct congestive profiles such as LV-dominant, RV-dominant, and biventricular (BiV) shock. AMI-CS is a significant challenge in health systems due to its multiorgan system ramifications. Early recognition and timely revascularization are critical for improving outcomes. The SHOCK trial demonstrated a 13% reduction in all-cause mortality in patients undergoing revascularization. The "golden hour" in CS management emphasizes prompt identification, revascularization, and admission to CICU. Emergency department care for CS requires prompt recognition by EMS and emergency department providers. Steps include early 12-lead ECG acquisition, administration of vasopressors, mechanical ventilation, point-of-care echocardiography, and immediate transfer to a primary PCI-capable facility. Transradial access is now the default for coronary angiography and PCI in patients with acute and chronic coronary syndromes. However, AMI