Iron overload cardiomyopathy is an old disease that has evolved from a rare undiagnosable and untreatable condition to a now much more common, diagnosable, and potentially treatable condition. Pathologically it is due to a direct free iron effect on the myocytes, and not due to interstitial infiltration. This also implies that the disease process is reversible if the tissue iron concentration can be controlled. The advent of magnetic resonance imaging and future genetic identification can identify the population at risk. Chelation therapy, including newer forms of oral chelators, likely will be more commonly available to benefit an ever increasing number and spectrum of the population. Further active research will be needed to improve our pathophysiological understanding and clinical treatment of this increasingly common condition.