Ankylosing spondylitis--cardiac manifestations.

There is a definite association of heart disease with ankylosing spondylitis (AS). The magnitude of this relationship is less clear. Three types of inflammatory affections can be differentiated: 1. aortitis and aortic insufficiency with the possible necessity of cardiac surgery, 2. conduction disturbances of the atrioventricular node with a probable subsequent indication for a pacemaker and 3. myocardial involvement with a possible compromise of left ventricular function. There seems to be an HLA B27-associated cardiac syndrome consisting of aortic root disease and conduction abnormalities. Patients can be recognized at pre-clinical stages. Prospective studies have not been performed. HLA B27-related heart disease does not seem to be associated with increased mortality.