The lymphatic vasculature, which accompanies the blood vasculature in most organs, is indispensable in for maintenance of tissue fluid homeostasis, immune cell trafficking and nutritional lipid uptake and transport, as well as reverse cholesterol transport. In this review, we discuss the physiological role of lymphatics in the heart, in maintenance of cardiac health, and describe alterations of lymphatic structure and function that occur in cardiovascular pathology, including atherosclerosis and myocardial infarction. We further discuss briefly the role that immune cells may play in the regulation of lymphatic growth (lymphangiogenesis) and function. Finally, we provide recent examples of how the cardiac lymphatics may be targeted therapeutically to restore lymphatic drainage in the heart in order to limit myocardial edema and chronic inflammation. Key points Cardiac lymphatics display a dynamic range of fluid uptake and transport, linked to cardiac contractility and heart rate Cardiac lymphatics undergo significant remodeling in several cardiovascular diseases, which can alter the lymphatic drainage capacity in the heart Insufficient lymphangiogenesis may contribute to the buildup of atherosclerotic lesions in large arteries due to accumulation of both lipids and activated immune cells Immune cells contribute to the process of lymphatic remodeling by stimulating or inhibiting lymphangiogenesis Therapeutic stimulation of cardiac lymphangiogenesis after myocardial infarction leads to accelerated resolution of myocardial edema and inflammation, promoting cardiac recovery