Why does cardiology have many extreme publishing authors?

Under diverse contributing factors in different scientific micro-environments, the number of authors who publish extreme numbers of full articles in a single year has increased. Cardiology is the subfield that has the largest share of authors with extreme publishing behavior than any other subfield in science (outside physics). Between 2000 and 2022, 137 authors in the subfield of Cardiovascular System (CVS, Science-Metrix classification) have published over 60 full articles in at least one calendar year and are also highly cited. The majority (70/137) are from Europe. All 7 countries with the highest prevalence of CVS extreme publishing authors per million population are European countries. Issues of massive authorship of papers by administrative leaders are discussed, including the arguments in favor of sustaining this practice and a refutation of these arguments. Other major contributors to the phenomenon are publications from clinical trials and epidemiological studies and massive authorship of highly cited guidelines. Micro-environments are instrumental in creating extreme publishing behavior in both developed and less developed countries. Listing of contributions does not solve the problem since contributions are also gamed; metrics that probe gaming are nevertheless available. Eventually, authorship carries both credit and accountability. The number of publications is a metric that can be heavily gamed. Emphasis should be given to what makes a major impact on science and human lives.