Alterations in myocardial membrane phospholipids may play an important role in the pathogenesis of ischaemic myocardial cell injury. Studies in canine myocardium, perfused rat heart, and cultured myocardial cells have demonstrated that the accumulation of free arachidonic acid correlates with the development of irreversible cell injury. Accumulation of other phospholipid hydrolysis products, including amphiphilic compounds such as lysophosphatidylcholine, has also been reported. The biochemical mechanisms which are responsible for phospholipid hydrolysis and arachidonic acid accumulation during ischaemia are unknown. This manuscript provides a synopsis of previous work in this field and suggests new directions for the field of myocardial phospholipid metabolism.