Histopathological alterations in the heart are often reported in fish as a result of exposure to a variety of chemical compounds. However, researchers presently lack a standardized method for the evaluation of histopathological alterations in the cardiovascular system of fish and the calculation of an 'organ index'. Therefore, we designed a method for a standardized assessment and evaluation of histopathological alterations in the heart of fish. As a model species, we used rainbow trout Oncorhynchus mykiss, but the protocol was also successfully applied to other fish species belonging to different taxonomic orders. To test the protocol, we re-evaluated sections of atenolol-exposed and unexposed rainbow trout obtained in a previous study. The results were in accordance with those previously published, demonstrating the applicability of the protocol. The protocol provides a universal method for the comparative evaluation of histopathological changes in the heart of fish.