Obstruction of LV inflow (mitral stenosis)
Diastolic dysfunction due to

Abnormal LV relaxation
Ischemia
Hypertrophy
Cardiomyopathies
High output states
Volume overload
Aging
Diabetes mellitus
Amyloidosis
Pericardial disease

For either systolic or diastolic heart failure the onset and progression of signs and symptoms can be quite variable and often do not correlate with the severity of LV dysfunction. Symptoms of volume overload, pulmonary congestion, dyspnea, and fatigue can occur at any point along the continuum of HF progression. Patients with acute myocardial infarction or other sudden hemodynamic change may experience an initial episode of HF that includes severe symptoms and dyspnea at rest. More often, in outpatient primary care patients initially present with noticeable fatigue or dyspnea only with physical activity or exercise. Effective compensatory mechanisms previously described may allow patients with systolic ventricular dysfunction, diastolic ventricular dysfunction, or both to function well
with mild infrequent symptoms for months or years. As the disease progresses symptoms often become more frequent and require regular medical intervention. The patient who finds physical exertion difficult often reduces the level of physical activity and experiences progressive skeletal muscle deconditioning. With severe disease, the patient is symptomatic at rest. Eventually, the heart develops a greater propensity for ventricular arrhythmias. Sudden death from ventricular arrhythmia is a common mechanism of death for HF patients with progressive LV dysfunction.

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