That apoptosis is mediated by specific pathways has long been established. However, more recent data have begun to suggest that necrosis may in fact be "programmed" and not a default "accidental" pathway as previously thought. The mitochondrial permeability transition pore, a known contributor to the development of many cardiac diseases, is emerging as one among several mediators of this necrotic program. Consequently, this report briefly reviews the roles of necrosis versus apoptosis in the pathogenesis of cardiac disease and discusses the role that the mitochondrial pore plays in cardiac necrotic cell death.