Clinical diagnostic criteria for cardiogenic shock should be based on pathophysiology.

Cardiogenic shock is a clinical syndrome characterized by cardiac pump failure, resulting in low cardiac output and subsequent tissue hypoperfusion. Current guidelines recommend diagnosing cardiogenic shock based on the presence of hypotension and signs of hypoperfusion. However, recent randomized clinical trials have demonstrated that these criteria are imperfect and may not reliably distinguish cardiogenic shock from other forms of shock, such as hypovolemic, distributive, or mixed types. Therefore, new clinical diagnostic criteria are urgently needed. A revised definition, grounded in the underlying pathophysiology, should diagnose cardiogenic shock based on low cardiac output, objective evidence of tissue hypoperfusion from reliable biomarkers, and the exclusion of hypovolemia. Enhancing the accuracy of cardiogenic shock diagnosis could significantly improve patient selection for therapies specifically targeted at this condition.