Cardiovascular involvement in systemic inflammatory diseases (SID) is underestimated despite its high mortality and morbidity. SID with cardiovascular involvement includes rheumatoid arthritis and the spondyloarthropathies, systemic lupus erythematosus, systemic vasculitides, inflammatory myopathies, systemic sclerosis, mixed connective tissue diseases (MCTD) and sarcoidosis (SRC). Cardiovascular magnetic resonance (CMR) is of great value in SID because myocardial inflammation, diffuse, subendocardial vasculitis and small scars due to inflammation or myocardial infarction and heart disease acuity can be detected neither by echocardiography nor by nuclear techniques; finally, most patients are unable to exercise adequately, and pharmacologic stress CMR is the best technique for coronary artery and cardiac microvascular disease assessment. However, lack of availability, expertise and high cost constitute serious obstacles for the routine application of CMR in every day practice.