The clinical course and echocardiographic and hemodynamic derangements in a case of uterine leiomyosarcoma metastatic to the heart are discussed. The literature on cardiac metastasis in general and cardiac involvement by leiomyosarcoma in particular is reviewed. Although the presentation of cardiac tumors is highly variable and the diagnosis is usually made postmortem, antemortem diagnosis is possible, as in this case, if a high index of suspicion is combined with information from two-dimensional echocardiography and cardiac catheterization.