Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ KEY FEATURES ++ ESSENTIALS OF DIAGNOSIS ++ Characteristic lumbar spine and sacroiliac arthritis Positive HLA-B27 assay Aortic root sclerosis and dilation, aortic valve leaflet thickening, and subaortic bump on echocardiography Aortic valve regurgitation ++ GENERAL CONSIDERATIONS ++ Ankylosing spondylitis is an inflammatory disease that mainly affects the vertebral and sacroiliac joints Less frequently, it affects other organs, including the heart Its incidence is 1 per 2000 people and occurs predominantly in white males < 40 years old Cardiac involvement usually follows articular manifestations by 1–2 decades The most common cardiovascular manifestations are: – Aortitis with or without aortic valve regurgitation – Conduction disturbances – Mitral regurgitation – Myocardial dysfunction – Pericardial disease Aortitis usually occurs in the proximal ascending aorta, frequently involving the sinuses of Valsalva and resulting in dilatation and thickening of the aortic root and annulus; the resulting leaflet retraction leads to mild to moderate aortic regurgitation Extension of this process into the anterior mitral valve leaflet may result in mitral regurgitation Extension of aortic fibrosis into the basal septum may interfere with the conduction system ++ CLINICAL PRESENTATION ++ SYMPTOMS AND SIGNS ++ Usually asymptomatic Dyspnea can occur Syncope can occur ++ PHYSICAL EXAM FINDINGS ++ Typical decrescendo diastolic murmur of aortic regurgitation Holosystolic murmur of mitral regurgitation Bradycardia ++ DIFFERENTIAL DIAGNOSIS ++ Other causes of aortic valve disease Other connective tissue diseases ++ DIAGNOSTIC EVALUATION ++ LABORATORY TESTS ++ Positive test result for histocompatibility antigen HLA-B27 ++ ELECTROCARDIOGRAPHY ++ High-degree atrioventricular (AV) block can occur ++ IMAGING STUDIES ++ Echocardiography findings: – Thickened, dilated aortic root with characteristic extension into the proximal anterior mitral leaflet (subaortic bump) – Aortic valve leaflet nodules Doppler echocardiography findings: – Color-flow Doppler evidence of aortic and mitral regurgitation ++ TREATMENT ++ CARDIOLOGY REFERRAL ++ Cardiac symptoms Significant heart murmur ++ HOSPITALIZATION CRITERIA ++ Heart failure Pericarditis Syncope High-degree AV block with bradycardia ++ MEDICATIONS ++ Specific anti-inflammatory pharmacotherapy Heart failure medications as appropriate Medications to control blood pressure as appropriate ++ THERAPEUTIC PROCEDURES ++ Pacemaker ++ SURGERY ++ Rarely valve replacement ++ MONITORING ++ ECG monitoring in hospital as appropriate ++ DIET AND ACTIVITY ++ Diet and activity guidelines as appropriate for the cardiac condition ++ ONGOING MANAGEMENT ++ HOSPITAL DISCHARGE CRITERIA ++ Resolution of problem Successful pacemaker placement Successful surgery ++ FOLLOW-UP ++ As appropriate for specific cardiac problem ++ COMPLICATIONS ++ Endocarditis... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. What is MyAccess? Create a FREE MyAccess profile to: Use this site remotely Bookmark your favorite content Track your self-assessment progress and more! GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessCardiology 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessCardiology Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options