Morphogenesis of atherosclerotic heart is presented on the basis of complex pathomorphological analysis of 1000 autopsies. Special attention was paid to the dilatation and hypertrophic variants and to structural mechanisms of heart and coronary vessel remodeling under conditions of atherosclerotic process. Predominant remodeling of atherosclerotic heart and coronary arteries by the dilatation variant determines unfavorable prognosis of heart failure. Compensatory and adaptive processes (cardiomyocyte hypertrophy and collateral circulation) developing in the heart compensate for functional insufficiency of the organ for some time.