The expression of genes changes during left ventricular hypertrophy. These changes are known as mechanogenic transduction. With respect to the two main contractile proteins, myosin and actin, this is due to a differential expression of their respective multigenic families. Changes of isoform are uncoordinated in time and space. It is important to recognise that the genes themselves are normal and that it is their regulation which is disturbed. Recent data shows that, under normal conditions, the regulation occurs at the transcription stage. A fuller understanding of these mechanisms is necessary if we are to comprehend the pathogenesis of cardiac hypertrophy and failure.