Microtubules (MTs) are dynamic, cytoskeletal fibers that are found in every eukaryotic cell type. MTs serve a wide range of functions, including cell division, membrane and vesicle transport, and motility. As such, MTs play pivotal roles in cardiac development and function. Agents that disrupt normal MT function, including such therapeutic agents as vincristine and paclitaxel, have also been shown to affect essential cardiac activities such as sarcomere mechanics, beat rate, and the secretion of important molecules (e.g., atrial natriuretic factor). Disease states that lead to either ischemia- or pressure overload- induced cardiac hypertrophy also alter the microtubule cytoskeleton in several ways. A fuller understanding of the contributions of MTs to cardiac development and function will be necessary to minimize the deleterious side effects of the therapeutic application of MT-disrupting drugs. This review summarizes current hypotheses and experimental results that demonstrate the central role of MTs in heart cell function and disease.