Background: Ankylosing spondylitis can lead to heart disease, including aortic incompetence, conduction defects, mitral valve disease, cardiomyopathy, and pericarditis. Early detection of cardiac abnormalities is crucial for effective treatment and prognosis, as they increase with age, disease duration, and peripheral arthritis presence. Objectives: This study aimed to determine the type, prevalence, and extent of cardiac involvement in patients diagnosed with ankylosing spondylitis. Methods: The study were collected in the Department of Medicine and Rheumatology units of Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital from January 2022 to December 2022. Diagnosis was established based on clinical features, physical examinations, and relevant laboratory and imaging studies. Patients with a history of rheumatic fever, syphilis, or those who declined participation were excluded from the study. Results: A total of 80 patients with ankylosing spondylitis underwent clinical examination, electrocardiography, and echocardiography to assess cardiac involvement. Among the participants, eight patients (10%) were found to have aortic insufficiency. Two patients had both aortic insufficiency and first-degree heart block, one had only first-degree heart block, and one had mitral insufficiency. Presents the cardiovascular manifestations detected in 12 patients (14%) with ankylosing spondylitis. Peripheral arthritis was present in 64% of the 12 patients with cardiovascular lesions, compared to only 34% of the 68 patients without such lesions. Conclusion: This hospital-based observational study investigated cardiac involvement in ankylosing spondylitis patients. Due to the small sample size, definitive conclusions were difficult to make, but the findings suggest that cardiac involvement is relatively common, emphasizing the need for early detection of cardiac abnormalities for effective treatment and prognosis.