This book reviews the basic knowledge about the cardiomyopathies and re-enforces the well-known definitions and classification of cardiomyopathies and specific heart muscle diseases, respectively. It emphasizes the importance of maintaining the classification into hypertrophic, dilated and restrictive cardiomyopathies, even though there are exceptions. The term realisations in the title is used in the sense of achievements and alludes to the progress in the understanding of heart muscle diseases over the last three decades and also to the areas of knowledge still not fully explored, for example, the as yet un classified putative cardiomyopathies such as arrhythmogenic right ventricular dysplasia, long QT syndrome and syndrome X. The accurate and sensitive identification of major risk factors for sudden death in hypertrophic cardiomyopathy needs further study, as do the implications of a familial basis in some patients with dilated cardio myopathy. The expectations mentioned in the title centre around the molecular biological aspects of viral myocarditis and dilated cardio myopathy and their relationship to each other; around the auto immune basis for dilated cardiomyopathy and its implications for drug therapy and cardiac transplantation; and around molecular genetic techniques for identifying the genes involved in hypertrophic cardiomyopathy that will be developed further. These will have implications for pre-natal recognition and for diagnosis in early life in apparently fit and active persons, and offer better prospects of prevention and cure.