This document delves into the complex world of mixed cardiogenic shock (CS), a condition characterized by the simultaneous presence of heart failure and at least one other shock state, typically vasodilation. The authors define mixed CS, emphasizing the importance of recognizing this distinct shock phenotype as it is now the second most common form of shock in contemporary cardiac intensive care units. They propose a classification framework to better identify and phenotype patients, discuss the pathophysiology of vasodilatory shock and septic cardiomyopathy, and address the challenges of risk stratification and treatment. The document concludes by outlining management considerations, including invasive hemodynamic monitoring, pharmacological interventions, and the potential role of temporary mechanical circulatory support (tMCS) devices. Notably, the authors emphasize the lack of robust evidence for managing mixed CS and call for further research to inform best practices and improve patient outcomes.