 Hello friends! Cardiovascular critical care refers to special systemic management of patients with severe cardiovascular diseases and post-cardiac surgery which consists of heart disease, vascular disease and valvular disease. Cases that are managed in a cardiac critical care unit are heart attack, heart failure, other serious cardiac conditions and diseases such as cardiomyopathy, arrhythmias, infection on the leaflets of heart valves. Often cardiovascular patients also have other systemic issues alongside such as respiratory failure, kidney failure, liver failure, infection or sepsis. Evolution to heart team has dramatically changed the way cardiac patients are managed in a cardiac critical care unit. This team namely consists of cardiologists, intensive care specialists, cardiovascular thoracic surgeons who often work in close-tandament coordination with one another to ensure smooth recovery and faster recovery of the cardiac patient. Doctors and nurses working in a cardiac critical care unit have extensive training in managing complex cardiac cases as well as training in systemic intensive care management because most often cardiac patients also have other systemic complications as well. The patient after heart surgery has multiple rapidly changing clinical problems. Initially these patients are unstable and their clinical status is extremely fluid and dynamic. Caring for the post-operative heart patient requires bedside presence and the knowledge of general fundamental concepts of critical patient care as well as concepts specific to this set of patients. The initial management of these patients as they return from the operating room is crucial as it sets tone for the rest of the recovery period. Upon the patient's arrival in the ICU, a thorough handover is obtained from the anesthesia and the surgical teams. It is as certain as to what procedure was done in the operating room, knowledge of interoperative events if any, which might impact patients post-operative course. Then a head to toe physical examination of the patient is done as part of this initial evaluation. At this time the patient is completely dependent on support systems and dysfunction of any of this can lead to disaster. The following points are monitored heart rate, rhythm, blood pressure, temperature, right and left filling pressures, hemodynamic profile, pharmacological profile, ventilatory status, chest drainage, neurologic status, ECG and chest x-ray. Most patients return to the ICU following heart surgery with an invasive arterial line, Foley catheter, usually a thermo-dilutional swan gans catheter. The hemodynamic status of the patient can be determined by careful assessment of the data provided by these monitoring devices. Most common post-operative problems are hemodynamic problems such as hypotension or hypertension, cardiac problem that is arrhythmia, hemorrhagic complications, non-cardiac complications, pulmonary complications, renal complications, metabolic complications, hematological complications, neurological complications, infectious complications at times as well as GI complications. Critical care of the cardiac surgical patient is a complex and dynamic endeavor. Adequate fluid resuscitation, appropriate inotropic support, attention to re-warming, ventilatory management and need for mechanical hemodynamic support when pharmacological support isn't enough are the key components in managing these patients. Having a specialized and dedicated cardiac critical care unit enhances patient management and recovery due to the team expertise in managing cardiac patients.