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In the cardiovascular intensive care unit (CVICU), hemodynamic monitoring provides the foundation for evaluating tissue perfusion, guiding fluid resuscitation, titrating vasoactive medications, and assessing response to therapy. However, the optimal approach to hemodynamic monitoring remains a subject of ongoing debate. This article highlights the nuances of hemodynamic monitoring in the CVICU and reviews both established and emerging technologies and how they may be combined with clinical judgement to optimize patient outcomes for the critically ill patients.