Abstract Background Ankylosing spondylitis is a chronic inflammatory autoimmune disease characterized by chronic arthritis of the sacroiliac joint and spine with ankylosis and ossification and may be associated with a variety of extra-spinal lesions involving the eye, bowel, and heart. Objective To study the cardiovascular manifestations in ankylosing spondylitis in a cohort of Egyptian patients. Patients and Methods In our study, 40 patients with AS were included; 32 of them were males and 8 females, all fulfilling the ASAS 2009 classification criteria. Results By performing ECHO, we found that valvular affection was the commonest findings as we detected TR in (42.5%), AR in (12.5%), MR in (7.5%), and PR in (2.5%) of patients. The second most common finding by ECHO among our studied patients is diastolic dysfunction in (25%) of patients followed by systolic dysfunction in (20%) of patients, intracardiac mass in (5%) and pericardial effusion in (2.5%). Regarding carotid duplex findings 21 patients (52.5%) had abnormal (increased) CIMT. Conclusion Cardiovascular system affection among ankylosing spondylitis patients is frequent, whether being clinical or subclinical and it is related in a way to high disease activity. Yet, it is still of question whether this affection is a result of the chronic inflammatory state and lack of activity both resulting from uncontrolled disease only or another multifactorial pathogenesis are coexisting.