The present study was designed to elucidate irreversible biochemical changes in the mitochondrial membrane of hearts subjected to hypoxia and subsequent reoxygenation in a rabbit heart Langendorff preparation. Significant changes in the mitochondrial calcium uptake, ATPase, and oxidative phosphorylation activities were seen in the heart receiving 30 to 60 min of hypoxic perfusion. These changes were accompanied by deleterious alterations in contractile function. Among hypoxia-induced changes in biochemical activities of isolated mitochondria, only oxidative phosphorylation activity was found to be irreversible upon reoxygenation. This is compatible with the findings of reoxygenation-induced incomplete recovery of tissue ATP level, once decreased by hypoxic perfusion. In the electron microscopic study, the heart receiving 60 min of hypoxic perfusion showed contracted sarcomeres, vacuolization and electron lucency of the mitochondria which were not restored by the subsequent reoxygenation. The results suggest that an inability of the mitochondrial membrane to produce high-energy phosphate primarily induces lack of ATP required for cardiac mechanical activity and membrane integrity, which in turn leads to the impairment of myocardial cell function.