This presentation focuses on clinicians doing cardiac imaging but also body imaging and who are involved in the evaluation and staging of systemic disease. The purpose of this talk is to indicate that certain primary single-organ diseases in their course can result in systemic disease, which potentially can involve the heart in different ways, e.g. functional impairment, inflammation or valvular disorders.Besides particular cardiac disease like congenital heart disease, ischemic heart disease or myocarditis the heart can be involved in numerous systemic disease entities. These include endstage kidney disease, liver cirrhosis, metabolic syndrome, amyloidosis, autoimmune disorders, hereditary metabolic defects and malignant disease. In addition to that, the heart can be affected by different treatment options of the afore mentioned diseases like chemotherapy or radiation therapy. Cardiac involvement can include coronary artery disease, valvular disease, endocardial, myocardial or pericardial disorders. Detailed knowledge of the potential cardiac alterations in systemic disease is key in their accurate diagnosis and treatment. Cardiac magnetic resonance imaging (MRI) is capable to visualize myocardial and valvular function with cine and phase contrast imaging and thus circumscribed dys-, hypo- or akenesia, general dys- or hypokenesia as well as valvular stenosis or insufficiency can easily be assessed. Perfusion imaging can be done at rest or under pharmaceutically induced stress to detect perfusion defects. Ischemic, inflammatory and fibrotic changes in in the endo-, myo- and pericardium can be visualized by delayed enhancement imaging. Hence, cardiac MRI is the ideal tool to visualize cardiac involvement in systemic disease. In addition to that the great arterial and venous thoracic vessels can be visualized in one comprehensive exam. MRI protocols need to be tailored with regard to disease entity and individual aspects of the patient such as renal function, arrhythmia and dyspnea. To account for the latter the toolbox for cardiac imaging includes breath-hold high-resolution single slice cine imaging, cardiac and respiratory gated phase contrast flow measurements and high resolution breath-hold Magnetic Resonance Angiography for patients in a relatively good condition or free-breathing real-time cine imaging, breath-hold phase contrast flow measurements and dynamic Magnetic Resonance Angiography for patients in an impaired general condition with the need for fast imaging. While most cardiac changes in systemic disease can be detected by standard sequences including cine imaging, late enhancement, T2 weighted sequences as well as phase-contrast imaging, new imaging techniques including T1- and T2-mapping hold promise to render new insights and to detect early disease stages. The aim of this talk is to give an overview on the most important systemic disease entities, typical patterns of cardiac involvement and findings on cardiac MRI. At the end of talk the audience should be able 1. To name important systemic disease entities with potential cardiac involvement 2. To determine adequate cardiac MRI protocols 3. To describe typical findings in cardiac MRI associated with systemic disease