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Cardiogenic shock is a life-threatening condition with a very poor prognosis. Many disorders may contribute to the development of shock. Of them, acute myocardial infarction is the main culprit. Despite tremendous progress in the field of interventional cardiology, in-hospital and long-term mortality still exceeds 50%. Data from large controlled trials on cardiogenic shock are scarce due to ethical reasons. Nevertheless, there is a chance for acceptable long-term survival in patients treated aggressively. The aim of this review is to summarise the key points of differential diagnosis and to emphasise that in most cases of shock due to acute myocardial infarction primary coronary intervention is the treatment of choice.