Human cardiac disease is the result of complex interactions between genetic susceptibility and environmental stress. The challenge is to identify modifiers of disease, and to design new therapeutic strategies to interrupt the underlying disease pathways. The availability of genomic databases for many species is uncovering networks of conserved cardiac-specific genes within given physiological pathways. A new classification of human cardiac diseases can be envisaged based on the disruption of integrated genomic circuits that control heart morphogenesis, myocyte survival, biomechanical stress responses, cardiac contractility and electrical conduction.