Background: Cardiovascular manifestations are one of the most common extraarticular features of ankylosing spondylitis (AS) patients. Objective: To characterize the cardiovascular symptoms of AS in a sample of Egyptian patients and to establish a connection between these symptoms and disease activity. Patients and Methods: Forty adults with Spondyloarthritis (SpA) were chosen at random from Ain Shams University Hospital and diagnosed using Assessment of Spondyloarthritis International Society (ASAS) criteria for current cross-sectional study. All patients underwent detailed history taking, full clinical examination, laboratory investigations including (CBC, ESR, CRP, lipid profile) resting electrocardiogram, cardiac echo and carotid duplex to measure Carotid Intima-Media Thickness (CIMT), and evaluate disease activity using the Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein. Results: The majority of patients (about 66%) experienced cardiac symptoms have had a valvular lesion, with tricuspid regurgitation being the most common symptom (42.5%) then diastolic dysfunction (25%) followed by systolic dysfunction (20%), intra cardiac mass (5%) and pericardial effusion (2.5%). Most of our patients had abnormal lipid profile (hypertriglycerdemia 87.5%, hyperchlostremia in 80%, high LDL in 90%), 21 patients (52.5%) had abnormal CIMT. The ASDAS-CRP score of the patients was ranged from 0.4-4.6. It was statistically significant correlated with age, multiple cardiovascular lesions as systolic dysfunction, diastolic dysfunction (p < 0.05), different forms arrhythmias, and CIMT (p < 0.05) although there is no statistically significant link to lipid profile (p>0.05). Conclusion: Cardiovascular affection in AS patients is frequent, whether being clinical or subclinical and it is related in a way to high disease activity.