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It is important to differentiate hypovolemic shock from cardiogenic shock, as many of the physical exam findings can overlap but the treatment is usually vastly different. Fluid therapy is generally contraindicated in most patients with cardiogenic shock. Cardiogenic shock can be due to forward (left‐sided) or backward (right‐sided) failure of blood flow. Common causes of cardiogenic shock include congestive heart failure, systolic dysfunction, as with dilated cardiomyopathy, diastolic dysfunction, as with hypertrophic cardiomyopathy, and arrhythmias [25, 26]. Clinical signs of cardiogenic shock include pale mucous membranes, heart murmur and/or arrhythmias, poor or variable pulse quality, pulse deficits, and tachycardia or bradycardia. Findings consistent with right‐sided heart failure include decreased ventral lung sounds consistent with pleural effusion, jugular venous distension, ascites, and hepatomegaly. Clinical signs seen with left‐sided dysfunction and left‐sided heart failure include increased respiratory rate or effort, respiratory distress, pulmonary crackles (pulmonary edema), and decreased lung sounds ventrally consistent with pleural effusion (cats).

In addition to history and physical examination findings, other diagnostics often needed to diagnose cardiogenic shock include ECG, blood pressure, pulse oximetry (SpO₂), thoracic radiography, and TFAST. TFAST can be used to determine cardiac contractility, myocardial thickness, and cardiac chamber (atria and ventricle) size. Focused echocardiography training for emergency veterinarians has been shown to improve their diagnostic capabilities for determination of several cardiac abnormalities [59]. Treatment may involve oxygen supplementation, pericardiocentesis, diuretic therapy, anti‐arrhythmics, vasopressors, or vasodilators depending on the etiology of cardiogenic shock.