Cardiomyopathy is considered a disease that affects the cardiac muscle itself without a known cause. This could be classified pathophysiologically into three main types: 1- Dilated cardiomyopathy (DCM); 2- Hypertrophic Cardiomyopathy (HCM) ; 3- Restrictive cardiomyopathy (RCM). The clinical aspects of the three types apparently look similar; the hemodynamic of each type differs from the others. Preoperative investigations are needed to estimate the myocardial efficiency and to specify the monitors and the anesthetic plan to be followed during surgery.Invasive blood pressure measurement during surgery appears to be important. Also, it is very important to measure the filling pressures of the right side of the heart and the cardiac output through a Swan-Ganz catheter to estimate the pulmonary artery pressure, pulmonary wedge pressure and the cardiac output. Preparation of the anesthetic plan of cardiomyopathic patients each patient must be evaluated before surgery to determine the type of cardiac lesion, cardiac efficiency, the hemodynamic derangement and how it could be compensated as well as the presence of any associated diseases. All of volatile anesthetic agents have a depressant effect on myocardial contractility so they can be replaced by narcotic analgesics such as fentanyl, sufentanyl and alfentanyl to ensure preservation of myocardial contractility. In cases of marked decreases of myocardial efficiency, preservation of the pulse rate is a must. This will broaden the negative effect of certain muscle relaxant that have a negative chronotropic effect such as atracurium and vecuronium. At the same time, it shows the positive effect of pancuronium for example.It is important to study the type of surgery and the possibility of using local techniques as well as the effect of spinal epidural block in cases of surgeries of the lower abdomen or lower limbs and the precautions to be taken if they are given e.g. monitoring of heart rate, systemic blood pressure, filling pressures of the right side and cardiac output in severe cases. The postoperative hemodynamic monitoring should be continued until the patient becomes stable. The follow up with blood gases is important as well, since, it could be affected as a result of postoperative pain or affection of the respiratory dynamics after anesthesia with narcotics as fentanyl, sufentanyl or alfentanyl. Drugs such as inotropes, calcium channel blockers and beta-blockers should be continued after surgery according to the hemodynamic status. Congestive heart failure, cardiac dysrhythmia, hypotension, hypertension, nausea, vomiting and other expected complications must be treated carefully in the intensive care unit.