Acute congestive heart failure (CHF) is a common clinical problem with a serious prognosis for the patient. For acute care hospitals, it is also the number one “money loser” for its diagnostic related group. For these reasons, it is important to understand how the critical care nurse can implement nursing measures and work within a multidisciplinary team to prevent complications in CHF patients. This article identifies the determinants of myocardial performance and nursing interventions that help lessen or prevent complications in CHF patients.