In the last decade, apoptosis has gained recognition as an important event determining the structure and function of the myocardium. The purpose of this review is to provide insights into the mechanisms controlling programmed cell death of myocytes. In this regard, the role of the local renin-angiotensin system and oxidative stress is emphasized. Moreover, the effect of cell death on ventricular remodeling and performance is analyzed. The impact of the identification of apoptosis in the heart on the current view of myocardium as a dynamic organ is discussed.