Purpose of Review <p>We provide an overview of cardiac metabolism, ketone physiology and terminology, methods of elevating ketones and their effect on cardiac function and disease. We discuss future research directions and speculate what ketogenic strategies may yield optimal effects on the heart and cardiovascular disease.</p> Recent Findings <p>Nutritional ketosis acutely elevates cardiac function (cardiac output, myocardial perfusion, etc.) in healthy people and those with cardiovascular disease in a dose-dependent manner between circulating ketones and cardiac function. Despite therapeutic potential, long-term studies have not been performed. This acute effect is rapid, dose-dependent, and has been seen to be durable for up to 14 days following intervention onset.</p> Summary <p>There are numerous methods to elicit ketogenesis and promote nutritional ketosis. There is growing evidence to suggest that higher ketone levels may offer greater cardiac benefits. It is pertinent to consider what ketone levels to target, and the best methods to safely and feasibly reach those targets over sustained periods of time.</p>