Læknablaðið : fylgirit - 01.05.1978, Page 96

excluded from the study. Patients with functional
murmurs, complete left or right bundle braneh
block or hemiblock and changes of repolarisation
in the E.C.G. were not inclosed in the study.
R esults:
Evaluation of 337 spondylitic patients revealed
a total of 27 patients with different cardiac
changes, i.e. 87o. In 11 patients we observed
valve disease. 7 patients had the typical finding
of aortic regurgitation: a high-pitched diastolic
murmur, a wide amplitude of blood pressure and
characteristical changes of carotis pulse curve
(Fig. 1). The age of these 7 male patients with
aortic incompetence ranged between 39 and 60
years with a mean age of 48 years. In all cases
except one valvular disease was previously un-
known. Three patients had history of discomfort
of the heart, two had diserete symptoms of heart
failure. Six patients had signs of left ventricular
hypertrophy in the electrocardiogram and three in
X-ray examination. In addition 7 cases had
conducting disturbances presenting a first degree
atrioventricular block. (Fig. 2).
Further two patients - one male and one female
person - showed aortic stenosis without any
subjective or objective symptoms.
In one patient aged 42 years we observed mitral
insufficiency. In another case mitral insufficiency
was combined with aortic stenosis. The latter
one claimed attacks of faint and vertigo and had
also symptoms of heart failure at exercise.
There is apparently a great variation regarding
the onset of heart disease after beginning of
ankylosing spondylitis. As an average heart valve
disease was detected after a 13,5 years course
of ankylosing spondylitis, ranging from 6 to 30
years individually. In the majority of the cases
the spondylitic process was already far advanced.
Conducting disturbances were diagnosed in a
total of 18 patients. 17 patients had a first
degree atrioventricular block and one a total
heart block. The coincidence of a first degree
av-block and aortic insufficiency in all 7 patients
must be pointed out. Most of the patients with
only conducting defects had no symptoms of heart
discomfort or heart failure. The patient with
total heart block was a sixty years old man
with no history of Adams-Stokes attacks.
Because of the age of the patient other causes of
the heart block cannot be ruled out. The mean
age of the group with conducting defects was 47,5
years and the duration of ankylosing spondylitis
was about 13 years.
Finally we found five patients with residual
signs of pericarditis in the E.C.G. consisting in
negative T waves in the leads I, aVl, V5 and V6
without changes of QRS and irreversible at
exercise. The mean age of the five patients was
44 years, the mean duration of ankylosing
spondylitis about 15 years. Two of them had
history of acute clinically diagnosed pericarditis
while three patients had no clinical manifestation of
pericarditis previously. E.C.G. changes suspective
for pericarditis were detected by a routine
examination.
In summary cardiac complications were found in
27 og 337 patients suffering from ankylosing
spondylitis. A review of the literature of the
last three decades illustrates the frequency of
cardiovascular complications in the course of
ankylosing spondylitis (Fig. 3). Aortic incompe-
tence is the predominating heart valve disease
ranging from 0,4 to 5% - in our study about 2%-,
conducting disturbances were observed in 0,7 to
CARDIOVASCULAR LESIONS IN 337 RATIENTS WITH ANKYLOSING SPONDYLITIS
n=27 (8'/.)
n % s AGE (YEARS) DURATION (YEARS) HEART SYMPTOMS HEART FAILURE LEFT VE^ HYPER ECG ITRICULAR TROPHY X-RAY
CONDUCTING DISTURBANCES 18 53 17 1 47.5 127 5 3 7 3
AV-BLOCK I.° ♦ 17 5 16 1 467 13.4 5 3 7 3
AV-BLOCK ino 1 1 60 2
HEART VALVE DISEASES 11 3,2 10 1 49.6 13.5 4 3 6 3
AORTIC INSUFFICIENCY** 7 2 7 46 11.1 3 2 6 3
AORTIC STENOSIS 2 1 1 56 17.5
MITRAL INSUFFICIENCY 1 1 42 6 MITRAL-
CONF
AORTIC STENOSIS AND
MITRAL INSUFF COMB 1 1 54 30 1 1
PERICARDITIS 5 1,4 5 44 14.8 2
•IN 7CASES ASSOCIATED WITH AORTIC INSUFFICIENCT
F i g U r e 2 . **IN ALL CASES ASSOCIATED WITH HEART BLOCK 1»
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