The myocardium, like other tissues, has enzyme and non-enzyme systems to neutralize free radicals. The enzymes superoxide dismutase, catalase and glutathione peroxidase and glutathione reductase as well as the non-enzyme antioxidants vitamin E and ascorbic acid are the main antioxidants. Oxidants are produced by the mitochondria under normal conditions and by other sources under pathologic conditions. The quantity of antioxidants present in the myocardium is matched to the production of oxygen free radicals that may be produced under basal physiological conditions. However, the myocardium can be exposed to increased levels of oxygen free radicals under conditions in which myocardial metabolism, i.e. mitochondrial oxidative phosphorylation, is accelerated to match the adenosine triphosphate utilized to support the increased work load on the heart or can be exposed to oxygen free radicals under pathologic conditions such as ischemia and reperfusion, inflammation, and cardiotoxic drugs such as anti-cancer agents. Under such circumstances the normal heart has been shown to increase its antioxidant production and to be, with time, protected from further sources of oxygen free radicals. In particular, hearts previously exposed to a stimulus to produce greater antioxidant levels show less damage during ischemia reperfusion injury presumably because of neutralization of oxygen free radicals. This review will present several situations in which the myocardium increases its tolerance to ischemia reperfusion injury as a result of an initial oxidative stress.