Although dyspnea, chest discomfort, edema, and syncope are car- dinal manifestations of cardiac disease, they occur in other conditions as well. Thus, dyspnea is observed in disorders as diverse as pulmo- nary disease, marked obesity, and anxiety (Chap. 33). Similarly, chest discomfort may result from a variety of noncardiac and cardiac causes other than myocardial ischemia (Chap. 11). Edema, an important find- ing in untreated or inadequately treated heart failure, also may occur with primary renal disease and in hepatic cirrhosis (Chap. 37). Syncope occurs not only with serious cardiac arrhythmias but in a number of neurologic conditions as well (Chap. 18). Whether heart disease is responsible for these symptoms frequently can be determined by carrying out a careful clinical examination (Chap. 234), supplemented by noninvasive testing using electrocardiography at rest and during exercise (Chap. 235), echocardiography, roentgenography, and other forms of myocardial imaging