ESC 2023 Guidelines — Cardiomyopathies

The 2023 guideline is the first ESC document to cover all cardiomyopathy phenotypes in one text, and it organises them by what the ventricle looks like rather than by presumed cause. That structure is itself examinable: the diagnostic pathway runs from phenotype through a multiparametric work-up to aetiology, and genetic testing enters at a defined point rather than at the start.

Genetics generates a reliable class of question, usually built around a relative. Who is tested, what a variant of uncertain significance permits, and what happens to a phenotype-negative family member when no pathogenic variant has been identified in the index patient — surveillance, not a predictive test.

The other clusters are risk stratification for sudden death, where the validated scores must be calculated rather than overridden by a single imaging finding; the sequencing of device therapy, including the rule that a defibrillator is not implanted while a ventricular arrhythmia is still incessant; and exercise prescription, which is restrictive in arrhythmogenic right ventricular cardiomyopathy and asked about often.