Cardiomyopathies, characterized by structural and functional abnormalities of the myocardium, present a diverse spectrum of etiologies, including genetic predispositions, environmental factors, and acquired diseases. This chapter systematically discusses the distinct pathways through which cardiomyopathies contribute to heart failure, considering both systolic and diastolic dysfunction, taking into consideration unique challenges in managing heart failure, necessitating a multifaceted approach that addresses both the underlying cause and the resultant myocardial dysfunction. Consolidation of current knowledge on the particularities of heart failure in cardiomyopathies is of utmost importance. A synthesized perspective on the diverse etiologies, molecular underpinnings, diagnostic advancements, and therapeutic considerations of hypertrophic cardiomyopathy (HCM), dilated and non-dilated left ventricle cardiomyopathy (DCM/NDLVC), arrhythmogenic cardiomyopathy (ARVC), restrictive cardiomyopathy (RCM) and syndromic and metabolic cardiomyopathies is provided.