 Typical treatment goals include identification of the causative disease process to facilitate therapy, recovery, and improvement of dyspnea symptoms. Initial diagnostic evaluation is centered about careful history taking and physical examination [1]. Physical examination findings in cardiac causes of dyspnea could include murmurs (eg, systolic murmurs in the setting of valve insufficiency) as well as an abnormality in heart rate or rhythm, extra heart sounds (S3 in setting of ventricular dysfunction, pericardial knock associated with constriction), or jugular vein distention and edema in heart failure. A nuanced accounting of relevant physical examination findings and history is beyond the scope of this document. Diagnostic investigation may be supplemented by chest radiography and electrocardiography (ECG) as well as laboratory testing. However, identifying the cause of dyspnea in some cases remains elusive [7], and advanced diagnostic imaging may play a critical role in the care of these patients. Special Imaging Considerations MRI imaging artifacts in patients with implanted electronic devices [8-11] and arrhythmias [12-14] can be mitigated with use of evolving imaging techniques. Point-of-care scanning with pocket echocardiography has improved time to definitive treatment (83 versus 180 days) and has been associated with improved outcomes, 15% versus 28% hospitalization or death, in a prospective randomized trial involving 253 patients in resource limited areas [15], whereas point-of-care echocardiography scanning with standard equipment obviated the need for formal scans in community patients with asymptomatic murmurs [16], with 100% of abnormalities identified on a point-of-care scan in 175 patients. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels.
Dyspnea Suspected Cardiac Origin Ischemia Already Excluded .  Typical treatment goals include identification of the causative disease process to facilitate therapy, recovery, and improvement of dyspnea symptoms. Initial diagnostic evaluation is centered about careful history taking and physical examination [1]. Physical examination findings in cardiac causes of dyspnea could include murmurs (eg, systolic murmurs in the setting of valve insufficiency) as well as an abnormality in heart rate or rhythm, extra heart sounds (S3 in setting of ventricular dysfunction, pericardial knock associated with constriction), or jugular vein distention and edema in heart failure. A nuanced accounting of relevant physical examination findings and history is beyond the scope of this document. Diagnostic investigation may be supplemented by chest radiography and electrocardiography (ECG) as well as laboratory testing. However, identifying the cause of dyspnea in some cases remains elusive [7], and advanced diagnostic imaging may play a critical role in the care of these patients. Special Imaging Considerations MRI imaging artifacts in patients with implanted electronic devices [8-11] and arrhythmias [12-14] can be mitigated with use of evolving imaging techniques. Point-of-care scanning with pocket echocardiography has improved time to definitive treatment (83 versus 180 days) and has been associated with improved outcomes, 15% versus 28% hospitalization or death, in a prospective randomized trial involving 253 patients in resource limited areas [15], whereas point-of-care echocardiography scanning with standard equipment obviated the need for formal scans in community patients with asymptomatic murmurs [16], with 100% of abnormalities identified on a point-of-care scan in 175 patients. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels.