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Ankylosing spondylitis (AS) is primarily characterized by back pain and reduced mobility in the lower spine. A form of axial spondyloarthritis, AS is further associated with several nonjoint complications, including heart disease.
An estimated 2 percent to 10 percent of people with AS experience some form of heart disease. Long-term AS and joint symptoms in the extremities may be risk factors for heart disease. Regular heart checkups and self-monitoring, as well as adopting a healthy lifestyle, can help prevent a more serious heart condition or slow its progression.
The exact mechanisms of how AS leads to heart disease are still under investigation. In general, it’s thought that the chronic inflammation associated with AS can reduce blood flow to the heart and damage the aortic valve. The long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), used to reduce symptoms of AS, also may increase the risk of heart disease. These NSAIDs, which include Advil (ibuprofen) and Aleve (naproxen), are commonly prescribed to treat inflammation and pain.
Ankylosing spondylitis is associated with several types of heart disease, some of which may cause similar symptoms, such as fatigue, dizziness, or chest pain.
The aorta is a large artery responsible for supplying oxygenated blood from the heart to the rest of the body. Aortitis is inflammation of the aorta. The condition most often leads to insufficient blood transport (called aortic insufficiency) and high blood pressure. Over time, the inflammation can result in a leaky valve, which may require surgery.
There are two types of aortic valve disease: regurgitation and stenosis. Aortic regurgitation occurs when the aortic valve does not seal properly, allowing some of the blood being pumped to flow backward into the heart. Aortic stenosis describes a narrowing of the aortic valve opening, which restricts blood flow to the aorta.
Both regurgitation and stenosis impair blood flow to the rest of the body and can result in chest pain, dizziness, and difficulty breathing.
Conduction describes how the electrical impulses that generate heartbeats are transmitted. Conduction disorders may result in a heartbeat that is too fast, slow, or irregular, called arrhythmias. Symptoms of conduction disorders can include:
Cardiomyopathy refers to changes to the heart muscle (such as scarring or enlargement) that diminish the organ’s blood-pumping ability. Symptoms of cardiomyopathy include:
If left untreated, cardiomyopathy may lead to heart failure, so early detection is important.
Also known as coronary heart disease or coronary artery disease, ischemic heart disease refers to a set of heart conditions in which the heart muscle is not adequately supplied with oxygenated blood. This is caused by a narrowing of the coronary artery. A person with at least one close family member with ischemic heart disease has an estimated 40 percent to 60 percent chance of developing it. Symptoms include chest pain or pressure, as well as trouble breathing.
You can take steps to protect your health and reduce your overall risk of developing heart disease, even with ankylosing spondylitis. Remember to eat well, exercise, sleep well, and stay on top of your doctors' visits.
Eating a varied diet that is low in trans and saturated fats and full of vegetables, fruits, whole grains, and fish can help lower your low-density lipoprotein (LDL) — or “bad” — cholesterol levels. Keeping your LDL cholesterol levels in check can help prevent plaque buildup in your arteries that disturbs blood flow.
Adopting a regular aerobic exercise routine is great for your heart, because it helps increase levels of high-density lipoprotein (HDL) — or “good” — cholesterol. HDL cholesterol is associated with a lower risk of heart disease. Try to get 30 minutes of moderate to vigorous exercise five day per week, which can also help in the management of AS pain.
A good night's rest can help control blood pressure and reduce your risk of having a stroke or heart attack, so getting at least six to eight hours is an important part of heart health.
You can help catch early signs of heart disease by staying attuned to your body and noticing changes. “I have to have a 24-hour heart monitor fitted to see what is going on with my heart,” wrote one MySpondylitisTeam member. “I have had AS for around 20 years now, and these symptoms started about two months ago.”
It’s important to make note and tell your doctor as soon as possible if you begin to experience any of these symptoms:
You may also want to ask your doctor if an echocardiogram is appropriate during your annual physical exam. An echocardiogram uses a combination of electrodes and ultrasound technology to provide information about the heart’s structure, rhythm, and blood flow to detect abnormalities or damage.
A combination of lifestyle changes, medications (such as ACE inhibitors or beta-blockers), and medical procedures may be part of your treatment plan. Even small lifestyle changes, like carving out time every day for some aerobic exercise, can help alleviate AS symptoms, increase blood flow, and strengthen your heart.
In some cases, a surgical procedure — such as the implantation of a pacemaker or a stent — might be necessary. “I had the fluttering heart and increase in blood pressure last year,” wrote one MySpondylitisTeam member. “They did a heart ablation and fixed it.”
Talk to your doctor about the best plan for you, if you need to treat a heart condition with your spondylitis.
MySpondylitisTeam provides you with access to a community of over 60,000 people living with spondylitis, more than 14,000 of whom have AS. They understand the challenges you may be facing and have found creative ways to cope.
Are you living with AS and a heart condition? What advice would you give to someone with a recent diagnosis? Share your thoughts below in the comments or join and post on MySpondylitisTeam.
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