Intercellular cross-talk is a fundamental process for spreading cellular signals between neighbouring and distant cells to properly regulate their metabolism, to coordinate homeostasis, adaptation and survival as a functional tissue and organ. In this review, we take a close molecular view of the underpinning molecular mechanisms of such complex intercellular communications. There are several studied forms of cell-to-cell communications considered crucial for the maintenance of multicellular organisms. The most explored is paracrine signalling which is realised through the release of diffusible signalling factors (e.g., hormones or growth factors) from a donor cell and taken up by a recipient cell. More challenging is communication which also does not require the direct contact of cells but is organised through the release of named signalling factors embedded in membranous structures. This mode of cell-to-cell communication is executed through the transfer of extracellular vesicles. Two other types of cellular cross-communication require direct contact of communicating cells. In one type, cells are connected by gap junctions which regulate permeation of chemical signals addressed to a neighbouring cell. Another type of cell communication is organised to provide a cytosolic continuum of adjacent cells joined by different tiny cell membrane extensions coined tunnelling nanotubes. In this review, we consider the various cell communication modes in the heart, and examples of processes in non-cardiac cells which may have mechanistic parallels with cardiovascular cells.