Care for the critically ill cardiovascular patients and their families requires a unique environment that is structurally different from other clinical units. Coronary care units were introduced in the 1960s for the main purpose of prevention and prompt treatment of life-threatening cardiac arrhythmias related to acute myocardial infarction. Since then, major progress in cardiology in general and acute cardiac care, in particular, dictated a major change in the structure and organization of these units, symbolically expressed in the new title of ‘intensive cardiac care unit’. Contemporary intensive cardiac care units receive older and more complex patients, often with multiple comorbidities and diverse diagnoses. The modern intensive cardiac care unit incorporates sophisticated monitoring and up-to-date equipment to meet the changing needs of the patient with cardiovascular disease requiring critical care. The intensive cardiac care unit operates in the centre of the hospital’s cardiology service, receiving patients from the mobile care unit (directly or via an ST elevation myocardial infarction network), the emergency department, and other wards, including coronary, structural, and electrophysiology intervention laboratories and operating rooms. Patients are usually unstable and require immediate full attention by highly trained medical and nursing staff. The 2005 recommendations for the structure, organization, and operations of the intensive cardiac care unit were issued by Hasin et al. for the Working Group of Acute Cardiac Care of the European Society of Cardiology, which serves as basis for this chapter. The chapter will focus on the requirements for staffing, training, and accreditation, as well as the structure organization and equipment of the intensive and intermediate cardiac care units.