A total of 474 patients (216 males and 258 females) with cardiovascular diseases which were followed in the cardiac clinic of the Gondar College of Medical Science Hospital, Gondar, Ethiopia, between 1985 and 1988 were studied. The commonest form of heart disease in Ethiopians was found to be rheumatic heart disease (42%), and affects mostly young people, who often have advanced valvular lesions. Hypertension (38.1%) was the second most common cause of heart disease. It affects mostly young people and 77% of the cases are of essential type. The incidences of atherosclerotic and congenital heart disease have not changed but that of syphilitic heart disease and cardiomyopathy have markedly decreased in the last 20 years. The incidences of rheumatic and hypertensive heart diseases have shown a significant increase. However, the rise in the incidence of myocardial infarction over a 20 year period from 0.88 per 1000 in 1963-68 to 6.4 per 1000 in 1985-88 is distinctively impressive.