The hallmark of all shock states is hypoperfusion. Cardiogenic shock generally presents with hypotension (systolic blood pressure [SBP] <90 mm Hg), although SBP may be greater than 90 mm Hg if there is preexisting hypertension or a compensatory increase in systemic vascular resistance. Sinus tachycardia is frequently seen, but may be absent in the setting of preceding calcium channel or beta-blockade. Evidence of hypoperfusion may include cool, mottled skin, oliguria, or altered mental status due to decreased cerebral perfusion and hypoxemia. Left ventricular failure may present with evidence of pulmonary edema: tachypnea, rales, wheezing, and frothy sputum. Jugular venous distention without pulmonary edema in the setting of hypotension should raise the suspicion of right ventricular failure due to infarction, tamponade, or pulmonary embolism. It is crucial to listen for the presence of a murmur that may represent acute valvular dysfunction (papillary muscle dysfunction or chordae rupture) or new ventricular septal defects as these findings may prompt life-saving surgery.