The last decade has seen great strides in the drug treatment of myocardial infarction and consequent heart failure, with associated improvements in quality of life, haemodynamics and survival. Despite this, the benefits of pharmacotherapy are limited in the more severe cases, and mortality and morbidity remain high. The ability to replace damaged myocardium by the use of stem cell therapy offers a new and potentially exciting treatment modality, but its benefits are at present far from established. Here we briefly review the current state of cardiac stem cell therapy and consider its future.