Advanced Cardiovascular Nursing requires thorough understanding of the underlying pathophysiology and clinical assessment skills. Hemodynamic monitoring involves assessing the relationship between blood pressure, cardiac output, and vascular resistance. Blood pressure equals cardiac output multiplied by systemic vascular resistance. The Frank-Starling mechanism describes how increased preload stretches myocardial fibers, increasing contractile force up to an optimal point. Beyond that point, the heart decompensates and cardiac output falls. Nurses caring for patients with conditions related to advanced cardiovascular nursing must be vigilant in their assessment and monitoring.