Subclinical Cardiac Involvement in Patients With Inflamatory Bowel Disease

Cardiovascular manifestations in patients with IBD mostly occur as immune-related consequences and include the following: pericarditis, myocarditis, venous and arterial thromboembolism, left ventricle impairment, arrhythmias and conduction disorders and valvulopathy . The prevalence of classical cardiovascular risk factors is relatively lower in IBD patients than in the general population . However, the risk of coronary heart disease is higher in IBD patients . The pathophysiology of cardiac involvement may be Systemic inflammation for prolonged periods that can cause platelet aggregation and endothelial dysfunction leading to the development of atherosclerosis and CVD . The chronic inflammatory condition found in IBD is the key element in the pathogenesis of arrhythmias. In IBD, inflammation causes mitral and aortic valvulopathies , excess TNF-α causes the thickening and shortening of the leaflets, resulting in regurgitation . Medications of IBD may be involved in pathogenesis of cardiac involvement as follows 5-ASA and its derivatives can cause myopericarditis . Atrial fibrillation and prolonged QT interval may occur during azathioprine use . Cyclosporine is associated with increased risk of hypertension, arrhythmias, acute coronary syndrome, and heart failure . Biological molecules are associated with increased arrhythmogenic risks . Primary preventive measures of arterial thromboembolism include maintaining the remission, strict control of cardiovascular risk factors . The diagnostic modalities to find out cardiac involvement include; The 12-lead electrocardiogram . Transthoracic echocardiography which represent the method of choice to evaluate both systolic and diastolic functions of Lt ventricle. Methodology: All Patints will be subjected to the followings : Full history taking including * Duration of illness * Symptoms of disease activity * Symptoms of extraintestinal manifestation * Family history of cardiac disease * History of traditional cardiovascular risk factors diabetes,hypertension,Dyslipidaemia,cigarette smooking) * Therapeutic history Examination * Body mass index. * Vital signs( pulse,blood pressure,temperature). * Cardiac examination. Labaratory investigations * Complete blood count - serum electrolytes * ESR - CRP * lipid profile - blood glucose level * TSH,T3,T4 ECG * Ischaemic changes * Any type of arrythmia * Prolonged QT interaval Holter ECG Echocardiography * Systolic and diastolic dysfunctions * Wall motion abnormalities * Valvular heart disease * Ventricular hypertrophy * Atrial and ventricular dimentions