I will always remember a young man I treated when I was a general practitioner in West Virginia. He was a coal miner working on the day shift before he got sick. For unknown reasons he developed cardiomyopathy and was in congestive heart failure (CHF). Nothing the cardiologist or I did seemed to stop his slow deterioration. He eventually died of idiopathic cardiomyopathy at age 26 leaving a wife and two young children. Today, he would have had a heart transplant. But why did his heart fail?