This review focuses on diastolic dysfunction with special emphasis on isolated diastolic dysfunction where impairment in diastolic function occurs in the absence of concomitant reduction in systolic function. The phenomena which influence diastolic function, the clinical spectrum of diastolic dysfunction, the physiological perturbations which may serve as therapeutic targets for pharmacological therapy and recent therapeutic trials are reviewed. Recommendations regarding the therapeutic approach to the patient with diastolic dysfunction are summarised.