The December 2004 conference on heart disease in Williamsburg, Virginia, was the 32nd such annual conference to be held in that city. The conference has been directed by one of the authors (WCR) since it began in 1972. It usually attracts about 200 enrollees, most of whom are repeat attendees. The conference provides 20 hours of continuing medical education credit, and nearly all of the speakers are nationally and internationally recognized. It is one of the longest-running cardiology courses sponsored by the American College of Cardiology. Its unique feature is that each presentation is 90 minutes, which allows most speakers time to discuss more than one topic and answer questions. The proceedings of the December 2002 and the December 2003 conferences were summarized in previous issues of Baylor University Medical Center Proceedings, and this article summarizes the proceedings of the 2004 conference. Unfortunately, the American College of Cardiology has decided to discontinue its sponsorship of cardiology conferences beginning in 2005. Moreover, the Williamsburg Conference Center will undergo extensive renovation in 2005 and therefore will not be available for meetings until 2006. Thus, there will be no 2005 Willliamsburg heart disease meeting, and the 2006 meeting, if held, will be sponsored by an organization other than the American College of Cardiology.