Myocardial pathologies and heart chamber abnormalities, including myocardial hypertrophy, thinning, perfusion defects, abnormal density (fat, calcium, and iron), abnormal trabeculation, abnormal contrast enhancement and chamber dilatation, may be incidentally detected on routine non-gated chest computed tomography (CT). Some cases may be asymptomatic, whereas others may involve symptoms and/or have important prognostic implications. Therefore, radiologists should be aware of the key imaging features of myocardial and heart chamber pathologies. This chapter discusses the potential role of routine non-gated chest CT in the diagnosis and management of myocardial pathologies and cardiac chamber abnormalities.