<prompt> . In cardiac shockSBP90mmof HgDBP80mmof HgUrine output 20 mlhrCardiac index 3.5  <response>: Cardiogenic shock CS is characterized by systemic hypoperfusion due to severe depression of the cardiac index and sustained systolic aerial hypotension 90 mmHg despite an elevated filling pressure . It is associated with in-hospital moality rates 50. . Circulatory failure based on cardiac dysfunction may be caused by primary myocardial failure, most commonly secondary to acute myocardial infarctionMI , and less frequently by cardiomyopathy or myocarditis , cardiac tamponade, or critical valvular hea disease Systolic and diastolic myocardial dysfunction results in a reduction in cardiac output and often pulmonary congestion. Systemic and coronary hypoperfusion occur, resulting in progressive ischemia. Although a number of compensatory mechanisms are activated in an attempt to suppo the circulation, these compensatory mechanisms may become maladaptive and produce a worsening of hemodynamics. Release of inflammatory cytokines after myocardial infarction may lead to inducible nitric oxide expression, excess nitric oxide, and inappropriate vasodilation. This causes fuher reduction in systemic and coronary perfusion. A vicious spiral of progressive myocardial dysfunction occurs that ultimately results in death if it is not interrupted. LVEDP, left ventricular end-diastolic pressure ref:harrison;s principles of internal medicine,ed 18,pg no 2232 