Chronic cardiac failure with normal left ventricular systolic function is observed in conditions without ventricular failure (pericardial adiastole, obstruction to intracardiac blood flow) or with ventricular failure due to isolated abnormalities of left ventricular filling. These forms of cardiac failure are often subject to diagnostic error. However, it is essential that they be recognised because traditional therapy must be used with caution and because of the efficacy of treatment of the underlying pathology whenever this is possible.