skip to main content

AS Cardiac Manifestations — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardSpondyloarthropathyAS Cardiac ManifestationsSCE Rheumatology

A 52-year-old man with a 24-year history of ankylosing spondylitis develops progressive exertional dyspnoea. His blood pressure is 158/52 mmHg and he has an early diastolic decrescendo murmur. ECG shows first-degree atrioventricular block. Echocardiography demonstrates moderate central aortic regurgitation through a trileaflet valve, with thickening and mild dilatation of the aortic root. Fibrous thickening extends across the aortomitral continuity to the basal anterior mitral leaflet, producing a subaortic bump. There are no vegetations and blood cultures are negative. Which pathological process best explains this constellation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — AS-associated aortitis with root dilatation and cusp fibrosis

This is AS-associated aortitis with secondary aortic regurgitation. Chronic inflammation and subsequent fibrosis affect the aortic root and cusps, producing root thickening or dilatation and cusp retraction. Extension along the aortomitral continuity can form the characteristic subaortic bump; involvement near the membranous septum may account for atrioventricular conduction disease. Infective endocarditis is less likely without vegetations or positive cultures and would more typically cause cusp destruction or perforation. A bicuspid-valve aortopathy is excluded by the trileaflet valve. Hypertrophic cardiomyopathy causes dynamic systolic outflow obstruction rather than this aortic-root lesion. Rheumatic mitral stenosis causes commissural fusion and a diastolic rumble, not central aortic regurgitation with root fibrosis.

Reference: Bengtsson K et al. Aortic regurgitation in ankylosing spondylitis—an echocardiography follow-up study. Clinical Rheumatology. 2025. https://pubmed.ncbi.nlm.nih.gov/39836332/