Based mainly on case material accumulated in the Pathology Branch, NHLBI, descriptions are presented of the gross anatomic, histologic and ultrastructural alterations of the heart in different types of cardiomyopathies, including hypertrophic cardiomyopathy, ventricular dilated cardiomyopathy, restrictive cardiomyopathy, the endomyocardial diseases, and various secondary heart muscle diseases, with emphasis on their differential diagnosis.