Damage to the heart muscle most often develops from coronary artery disease (CAD) related myocardial infarction, usually in people in their middle or later decades. Inherited forms of heart muscle disease (Cardiomyopathies) are the most prominent cause of myocardial disease in the young. Myocardial infarction and cardiomyopathies are the major causes of heart failure and arrhythmic sudden death. We undertake translational research focused on determining those at risk (genomics), with an aim of preventing or minimising myocardial damage by early disease recognition and treatment with techniques such as ischaemic preconditioning. Arrhythmia and heart failure research is concentrated on implementation of new treatments, development and trials of novel device therapies, and the assessment of ‘improvements’ in healthcare delivery.