The recent revision (table 1) of the definition of a cardiomyopathy by the World Health Organization1 recognises that ventricular dysfunction can result from a failure to correct volume or pressure overload in valve disease or to control hypertension. Loss of myocardium caused by coronary artery disease also leads to severe ventricular dysfunction. All of these end stage conditions are categorised as specific cardiomyopathies. The second form of cardiomyopathy is caused by intrinsic disorders of the myocardium itself and is subdivided on the basis of the pathophysiology. Such a functional rather than an aetiological classification has drawbacks but reflects our current state of knowledge. The different functional abnormalities produce characteristic changes in ventricular shape easily recognised in short axis echocardiographic planes and by pathologists (fig 1).