About half of patients with symptoms and signs of heart failure will be found to have a normal or

near-normal left ventricular ejection fraction (LVEF) . These patients are mostly elderly women,

and the majority have a history of hypertension in contrast to a predominantly ischemic aetiology

in those with heart failure and a reduced ejection fraction (HFREF). Heart failure with a normal

ejection fraction (HFNEF) is proving to be intriguing with only a few established facts but many

myths. First, the precise underlying pathophysiology is still debated.