The review of the progression in the pathophysiology and therapy of cardiogenic shock (CS), especially in the setting of acute myocardial infarction (AMI). CS represents the most serious contractile dysfunction and is still a serious condition with high mortality rate. It is the main reason for in-hospital mortality in AMI. Except for mechanical impairment of the myocardium, there is always an abnormal inflammatory response with activation of systemic NO synthase (sNOS) with an abnormal level of NO. A few small studies with evaluation of sNOS inhibitors are contradictory. From the mechanical complications of the AMI, the worse prognosis is found in acute myocardial interventricular septal rupture (82 %) despite surgical treatment. The use of stenting with IIb/IIIa inhibitors, improvement of a technique of the percutaneous coronary angioplasty (PCI), coronary artery bypass (CABG) and perioperative care have all contributed to the better results. It has been shown that the only treatment which improves the prognosis of patients is early revascularization with mechanical support. If it is impossible to perform PCI or CABG trombolysis is clearly indicated, even if it is not as effective during hypotension in connection with extensive coronary artery disease. At the present time, apart from intraaortic balloon contrapulsation (IABC), there is a new generation of the transcatheter mechanical support devices, (i.e. Impella Recover® a Tandem HeartTM and long term implantable ventricular assist devices). Their use has to be combined with a heart transplant program. Only 20 - 30 % of patients present with early CS. In the remaining, CS develops later. The prognosis of these patients is even more strongly influenced by rapidity of the revascularization than in stable patients. So it is extremely important to identify the stable patients with an adverse prognosis. The mortality rate from the 1980s to the present has decreased from approximately 80 % to the 50 - 60 % but is still very high. The complex, very expensive and technically demanding care can be provided only in specialized centres where the patients with CS should be transferred.