Tumours metastatic to heart (cardiac metastases) are among the least known and highly debated issues in Oncology, and very few systematic studies are devoted to this topic. Although primary cardiac tumours are extremely uncommon [various post mortem studies report rates between 0.001% and 0.28%], secondary tumours are not, and at least in theory, the heart can be metastasized by any malignant neoplasm able to spread to distant sites. In general cardiac metastases are considered be rare, however when sought for, the incidence may appear to be not as low as expected being present in almost 10% of all cancers. Although no malignant tumours are known which diffuse preferentially to the heart, some do involve the heart more often than others – as for instance melanoma and mediastinal primary tumours. This paper attempts to review the pathophysiology of cardiac metastatic disease, epidemiology and clinical presentation of cardiac metastases, and pathology characterization of the lesions.