The major goals of this presentation are to give the updated knowledge of primary heart muscle disease, cardiomyopathies (CMP), their classification, the diagnostic possibilities using endomyocardial biopsy (EMB) and to estimate the value of EMB in the choice of the right therapeutic approach. Despite many controversies, EMB is today a widely accepted method, with low percentage of complications for analysing CMPs, and is considered to be a routine procedure in many cardiological centers. Inspite the fact that we started with the use of EMB in 80’s, it is not performed often today in Belgrade, like many yeras ago (2). It’s difficult to say why ? The CMPs may be subdivided, according to the functional and structural features, into two groups: idiopathic and specific, or primary and secundary. Idipathic group is consisted of 5 subgroups: hypertrophic, dilated, restrictive, arrithmogenic right ventricular CMP and unclassified. Specific CMPs may be subdivided into 8 groups mainly based on etiopathogenetic characteristics: infective, with viral myocarditis as the most common entity, metabolic, including endocrine disorders and infiltration and storage diseases. Deficiency disorders and heart involvement in connective tissue disorders are also included. Granulomas, neoplasms and neuromuscular disorders are also wery often presented with cardiac disfunction and structural abnormalities. Sensitivity and toxic reactions with long list of substances wich may affect the heart are probably the most present today. Finally, the last group represent miscellaneous systemic syndromes with heart affection. EMB has been increasingly used in the diagnosis of CMPs, with special influnce on diagnosis of heart transplant rejection, myocarditis, treatment modalities of different types of myocarditis, with low complication rate, considered effective, usefull and safe procedure.

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