The future of cardiac surgery seems to be in dark because of improved health awareness in public and improved cardiac Cath quality stents. I am discussing in my editorial how the cardiac surgery has evolved from nowhere to everywhere. But as there are ups there are downs also. The downward phase of cardiac surgery has started and now only we has to act otherwise we again go back to nowhere.

The most common cardiac arrhythmia encountered in clinical practice is atrial fibrillation (AFib). AFib has significant effects on long-term mortality and stroke, and contributes greatly to overall healthcare costs, affects quality of life and the functional status of many patients [1]. The incidence and prevalence of AFib continues to rise with age, when comorbidities that affect rhythm management frequently coexist [1].

Coronary artery aneurysm (CAA) is an uncommon finding in patients undergoing a coronary angiography, with an incidence of less than 5% [1]. CAA is defined as coronary dilation of more than 1,5 times the adjacent vessel diameter. The majority of CAA in adults are of an atherosclerotic origin [2].

Background: The study of coronary artery disease has been quite thorough. But there is few study on coronary vein disease. In clinical practice, some patients have suspicious symptoms of coronary artery disease without any evidence of coronary artery spasm, but coronary angiography showed no obvious stenosis in coronary artery. It may have relationship to coronary venous dysfunction. This study aims to develop a coronary vein ligation model, to investigate the effect of coronary vein occlusion on myocardial cells in normal miniature pigs.

Cardiac lesions resulting from blunt chest injuries can present as cardiac contusion; ventricular free wall rupture; ventricular septal rupture; and valvular lesion [1]. But acute Myocardial infarction (MI) from contusio cordis is a very rare complication. Here we present a case of fist punch to the chest leading to distal Left Anterior Descending (LAD) artery dissection causing acute MI.

Postoperative atrial fi brillation (AF) has a high prevalence, affecting up to 45% of coronary artery bypass graft surgery patients within the fi rst week of the operation [1-4]. Interestingly, asymptomatic AF was reported more likely to occur after the fi rst 4 days following the cardiac surgery. Postoperative AF is associated with increased morbidity and several types of complications. It was associated with increased duration of hospitalization, with high healthcare costs, and has been associated with an increased incidence of stroke, the need for permanent pacemaker placement, and early and late mortality. Several factors were found to be associated with new-onset AF following multivariate analysis, including advanced age, higher Killip class or heart failure, hypotension, higher heart rate, history of hypertension, history of stroke, female gender, increased peak creatinine, and increased Creactive protein levels [5-9]. In addition, AF may adversely affect quality of life and is associated with a higher risk of acute heart failure, and with thromboembolic events. It has recently been demonstrated that early and late postoperative AF have different predictors [9]. Early postoperative AF is the one occurring within the first 5 days after cardiac surgery, and late postoperative AF is the one occurring between the 6 and 30 days after cardiac surgery.

I had a privilege of having a really attentive and good medical student rotating through my cardiology office for a month. One day I explained to her in greater details that in spite of all the tests, devices and everything else, the patient history is still the MOST important aspect of overall medical evaluation of a patient. With this advice, I sent her to go to see a patient of mine admitted to the hospital with palpitations.