The prognosis of cardiac arrest (CA) remains poor, with a survival rate at hospital discharge between 6 and 10%. To improve this disappointing outcome, efforts are needed regarding each step in the chain of survival. In this review, the authors focus on cardiac issues, as the heart itself could be both a cause and a target in this setting. Acute myocardial infarction is very illustrative of this duality. As it is a frequent cause of CA, an early invasive strategy (through immediate coronary angiography) has been proposed by several teams and is now recommended in specific situations. In addition, a postresuscitation syndrome is commonly observed in these patients, which often includes transient myocardial dysfunction. Identification and management of this cardiac complication is a key target in the hemodynamic management of these patients. Finally, regarding survivors at hospital discharge, secondary prevention targeting the risk of recurrence of cardiac arrhythmia is mandatory in specific indications (especially through implantable cardiac defibrillators). Overall and as a truism, cardiac issues are crucial before, during, and after occurrence of CA.