Idiopathic dilated cardiomyopathies are the most frequent cardiomyopathies and represent a major public health problem. The aim of this work was to study the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of idiopathic dilated cardiomyopathies at the Hospital de la Paix in Ziguinchor. We had conducted a retrospective and descriptive study at the cardiology department of the Hospital la Paix of Ziguinchor. We included in the study all cases of confirmed cardiomyopathies by echocardiography with diagnostic criterias as left ventricular dilatation ≥ 59 mm in men and 53 mm in women, associated with left ventricular dysfunction with an ejection fraction <45% without detectable etiology. We selected 79 patients with an average age of 61.51 years, there SAS a male predominance of 60.8%. Idiopathic dilated cardiomyopathies accounted for 35% of the causes of cardiomyopathies. Clinically, all our patients were in heart failure and exercise dyspnea was the main symptom. In the chest X-ray, cardiomegaly was found in 94.9% of cases and electrocardiogram left ventricular hypertrophy was the most common abnormality (41.8%). On transthoracic echocardiography Doppler, the average telediastolic diameter of the left ventricle was 63.08 mm and the average left ventricular ejection fraction was 32.46%. Medical treatment relied mainly on diuretics and angiotensin-converting enzyme inhibitors. The mortality rate was 19%. Idiopathic dilated cardiomyopathy is the most common type of cardiomyopathy. In the absence of adequate means of exploration in our developing countries, the diagnosis is based on simple anamnestic, clinical and paraclinical arguments, of which the Doppler echocardiogram is the cornerstone. The mortality rate remains high despite the therapeutic advances made in recent years.