Data on absorption and consumption in heart tissue of free and ester-bound fatty acids from blood lipids are discussed. Preferential utilization of individual fatty acids in heart tissue from blood lipids is considered. Dependence of fatty acid metabolism on the activity of tricarboxylic acid cycle, interrelationship between metabolism of endogenous and exogenous fatty acids in heart muscle are considered. The data are analyzed on pathways of exogenous fatty acids turnover in tissues, their conversion into endogenous fatty acids, specific for individual tissue, cells and their organelles. Development of syndrome of unsaturated fatty acids deficiency, induced by incomplete fatty diet, is discussed. Metabolism of fatty acids in heart under conditions of oxygen deficiency is considered. The data are reviewed on the effects of hypoxia on metabolism of fatty acids in myocardium. Carbohydrate and fatty acid consumption in heart muscle, typical alterations in fatty acid incorporation into heart lipids, effect of fatty acids excess on functioning of sarcoplasmic reticulum and mitochondrial membranes are discussed.