The regulation of protein synthesis in heart muscle has been investigated by many authors under both normal and pathological conditions. This review summarizes the evidence for the dependence of normal heart protein synthesis from normal serum levels of insulin, amino acids, fatty acids and glucose. A decreased serum concentration of these substances causes an inhibition of heart muscle protein synthesis by 30--60%. Various drugs and other chemical lead to similar impairments of heat muscle protein synthesis. The resulting imbalance between synthesis and degradation of myocardial proteins with their half-times of 5--12 days gradually leads to a decrease in their myocellular concentration with a consequent impairment of myocardial function. Finally, the biochemial sequences are described which represent the important pathogenetic mechanisms in the development of heart muscle hypertrophy and in the adriamycin-induced cardiomyopathy.