Systolic heart failure is a classic heart failure where the inotropic (contractile) state is impaired and the expulsion of blood is not adequate. So the main manifestations of systolic failure are due to inadequate cardiac output and fluid retention.

Diastolic failure has been a less familiar entity so far and is due to a defect in ventricular filling. The ability of ventricles to accept blood is impaired. In this, there is incomplete ventricular relaxation, transiently as in myocardial ischemia, or in a sustained form as in restrictive cardiomyopathy. The major manifestations are due to elevated ventricular filling pressures, leading to pulmonary or systemic venous congestion in the presence of preserved left ventricular systolic function (i.e. normal left ventricular ejection fraction and end-diastolic volume).