Heart problems associated with spondylitis

Spondylitis refers to the inflammation of the spine bones or vertebrae which may leave the spine hunched. It is a rare type of arthritis which is featured by pain and stiffness in the spine which spreads to the neck and damages joints in the body.

It is known as Ankylosing Spondylitis (AS), where Ankylosing refers to fused bones and Spondylitis refers to inflammation. Pain and stiffness are experienced in lower back, buttocks, shoulders, hands, rib cage, hips, thighs, feet and heels. Pain gets intense after sitting for more time and besides tiredness one could experience swelling in the joints. Though this disorder cannot be cured, the pain could be kept in control through exercise and medication.

Inflammation in sacroiliac joints and other joints in spine and hips cause low back pain and stiffness which increases risks of heart diseases.

Besides making the vertebrae weak enough to fracture and causing uveitis or inflammation in the eye that could blur vision, spondylitis affects the heart valve. Besides irregular heartbeat, atherosclerosis, it enlarges the aorta which is the largest artery in the body, owing to which blood leaks back to the heart. Consequently heart does not pump properly and leaves patient tired and short of breath.

Spondylitis patients lesser than 40 years old and those with tumour necrosis factor inhibitors are prone to develop atrial fibrillation which causes irregularities in heartbeat which is also termed as arrhythmias, can be known as tachycardia when too fast and bradycardia when too slow.

Reportedly 2 to 10 per cent of spondylitis patients have cardiac manifestations. The earliest reference of aortitis or inflammatory changes in aortic wall was found in 1930s. Both aortic pathology and its risks are linked with spondylitis.

Spondylitis increases possibilities of cardiac problems including ischemic heart disease which is recognised by symptoms such as chest pressure, angina and low tolerance for activity. Inflammation and scar tissue around the ribs cause tightness in the chest and the pain worsens when patients cough or inhale. Angina occurs when meagre blood flow gets into the heart. Spondylitis is also associated with conduction disturbances and cardiomyopathy.

Patients must abstain from smoking, reduce obesity, take up regular exercises and make suitable changes in diet to reduce chances of cardiovascular diseases.

Medications like non steroidal anti-inflammatory drugs which are used to treat ankylosing spondylitis may also increase risks of heart disease. Not only inflammation but also treatments to minimize inflammation place patients at risks. While regular exercises curb risk of heart diseases, spondylitis pain does not allow one to do exercises.

Patients with Ankylosing Spondylitis are more susceptible to high cholesterol and high blood sugar besides obesity, which are all factors that increase heart diseases.

Medications for ankylosing spondylitis include non-steroidal anti-inflammatory drugs, methotrexate which is used for arthritis symptom relief, tumour necrosis factor antagonists, corticosteroid injections and opioids to treat pain.

Physiotherapy including cardiovascular exercises, core strengthening, stretching, isometric strengthening, breathing exercises, dynamic movements and fall prevention exercises help to maintain good posture and decrease pain. Posture training prevents the spine from becoming frozen.

Patients must avoid entities including high impact activities and contact sports, use of narcotics and sleeping pills, alcohol and sleep in thin pillow which avoids developing deformities in the neck. Heat or cold therapy, Transcutaneous electric nerve stimulation or TENS can treat the issue while surgery like Laminectomy is performed to relieve pressure from nerve roots.

Influence of ankylosing spondylitis in cardiovascular system may have mortality and morbidity effects on the patient and if patients develop chest pain, aortic dissection and emergency interventions should be considered. Cardiological examination of patients with ankylosing spondylitis must be emphasised, especially in those with long term disease.