Prof. Evgenij Potapov, MD, a cardiothoracic surgeon at the German Heart Center Charité, discusses some basic hemodynamic concepts and identifies what he believes are the primary issues in patients with cardiogenic shock. “The catecholamines are not friends,” he states, explaining that vasopressors and inotropes increase myocardial oxygen demand and predict mortality in patients with cardiogenic shock. He identifies 4 main problems in cardiogenic shock: transmural flow, overloading the failing left ventricle on veno-arterial extracorporeal life support (VA ECLS), right ventricular failure, and hypotension in SIRS-like status as a sequella of hypoperfusion. He then presents his solution to these 4 problems: the proactive concept of combining optimal body perfusion and unloading of the left ventricle. “Play chess with death,” he concludes, “You can do it, but you have to have right concept and you will win, mostly.”