This chapter will outline the anatomy and physiology of the cardiovascular system and the changes that occur during childhood as this body system matures. Signs and symptoms of cardiovascular failure and nursing assessment and monitoring of the child will also be discussed. This knowledge will enable the nurse to recognize cardiovascular failure as early as possible and commence appropriate interventions. A range of interventions and clinical skills required for cardiovascular support are also explained, utilizing evidence-based guidelines. All aspects of care will be discussed using a family centred and child-friendly approach. The Nursing and Midwifery Council (NMC) introduced the use of essential skills clusters (ESC) to help pre-registration nursing students meet the standards of proficiency required for registration (NMC, 2007b). They are written from the perspective of what the public can expect of a newly qualified nurse and are designed to improve safe and effective practice. The information contained within this chapter covers aspects of most of the skills clusters. In particular, the underpinning principles from: care, compassion, and communication (1); organizational aspects of care (9, 10); infection prevention and control (22, 25, and 26); and nutrition and fluid management (29, 32) which are integrated throughout the discussion. At the end of this chapter you will: ● Understand the anatomy and physiology of the cardiovascular system and the changes that occur during childhood as this body system matures. ● Learn to recognize signs and symptoms of cardiovascular failure. ● Be familiar with nursing assessment and cardiovascular monitoring of the child. ● Understand how the nurse recognizes cardiovascular failure as early as possible and commences appropriate interventions. ● Begin to develop an understanding of the range of interventions and clinical skills required for cardiovascular support. The cardiovascular system is vital for supplying the tissues of the body with blood. This blood supply enables the needs of individual cells for oxygen and nutrients and removal of waste products to be met (metabolic demands). The body is also able to achieve these functions under a variety of circumstances: at rest or sleeping; during exertion through exercise; and during the extra demands placed on the body as a result of illness.