The natural history of dilated cardiomyopathy, above all in asymptomatic patients, is not easily predictable. Nevertheless, when congestive heart failure is present, prognosis is significantly worse. The development of new therapeutic methods, both pharmacological (angiotensin converting enzyme inhibitors and other drugs) and surgical (heart transplantation), have improved the prognosis of this disease. In this article, we review some subjects of interest related to the management and treatment of patients with dilated cardiomyopathy that have been studied recently: identification of potentially reversible causes, optimization of medical therapy, prognostic markers, identification of high-risk patients and selection of candidates for heart transplantation.