Catecholamines play a pivotal role in regulating both cardiac physiology and pathology, orchestrating the “Fight-or-flight” response through the activation of sympathetic nervous system (SNS) activation and subsequent stimulation of adrenergic receptor. However, chronic stress and various cardiac diseases can disrupt catecholamine balance, contributing to cardiac dysfunction. The synthesis, release, reuptake, and degradation of catecholamines intricately regulate their concentration. Notably, catecholamine dynamics is markedly altered in heart diseases, including heart failure, myocardial infarction, and arrhythmias. While β‍-adrenergic receptor blockers, which block catecholamines from binding to the adrenergic receptors, are widely used in clinical settings, the potential implication of directly manipulating catecholamine homeostasis for the treatment of cardiac diseases have not been extensively explored. This review provides an overview of catecholaminergic systems, and discusses their intricate synthesis, release, uptake, and metabolism within the heart. Additionally, the review highlights mechanisms underlying cardiac effects of catecholamine dysregulation, including contractile dysfunction, electrical remodeling, and cardiac remodeling. Moreover, the review emphasizes the importance of considering spatiotemporal and sexual heterogeneity in catecholamine dynamics for cardiac precision medicine. In terms of future perspectives, we believe that harnessing genetically encoded fluorescent biosensors to map the heterogenous for real-time imaging of catecholamine dynamics and conducting gender-specific dissection of catecholamine dynamics have significant potential to advance personalized management of cardiac diseases management.