Abstract <p>Lead is a widespread environmental xenobiotic that contaminatessoil, water, air, and food. In recent decades, considerable attentionhas been paid to the effects of lead on the cardiovascular system andits association with cardiovascular risks. According to the WorldHealth Organization’s 2019 statistics, 4.6% of all cardiovasculardiseases worldwide, more than one million deaths and 21.7 milliondisability-adjusted life years were attributable to lead exposure.This review focuses on the cardiotoxic effects of lead, which occureither directly through its action on cardiomyocytes or indirectlythrough effects on innervation, humoral responses, or vascular changes.Studies at all levels of cardiac organization (organ, tissue, molecular)are described. Particular attention is paid to the molecular mechanismsof direct and chronic toxic effects of lead, specifically, its saltsand nanoparticles. The review compares the molecular and cellularmechanisms of lead toxicity in the right atrium and ventricle, aswell as its action on all heart chambers as a whole. The resultshighlight the chamber-specificity of lead effects, specifically,the increased susceptibility of atrial tissues to lead-induced injury,and indicate the importance of considering chamber-specific effects whenassessing cardiovascular risks associated with environmental cardiotoxicants.Furthermore, these data emphasize the need for targeted therapeutic strategiesto attenuate lead-induced cardiac dysfunction.</p>