In the therapy of cardiogenic shock, it is difficult to develop a rationale for the use of norepinephrine and metaraminol in doses where alpha adrenergic activity predominates and which restore normal arterial blood pressures. The use of doses sufficient only to maintain renal perfusion pressures may be beneficial as a consequence of the beta adrenergic effect on the heart. Agents possessing pure alpha adrenergic activity (methoxamine, phenylephrine) would appear to be contraindicated in cardiogenic shock. Isoproterenol and dopamine are agents lacking in significant peripheral vasoconstrictive action but exerting a prominent action on the heart. The use of these agents constitutes one of the most recent approaches to cardiogenic shock but insufficient data are available for evaluation of their roles. The use of alpha adrenergic blocking agents is rational in the treatment of cardiogenic shock, but they may produce severe depression of the blood pressure in a hypovolemic subject. The use of such agents conjointly with norepinephrine, epinephrine or dopamine (but not isoproterenol) may be a promising approach. There would appear to be no pharmacological basis for the use of beta adrenergic blocking agents in cardiogenic shock or hypotension.