SUMMARY
Background: Antiphospholipid syndrome (APS) is a multisystem autoimmune disease, characterised by thrombotic and/or obstetric complications in the presence of persistently positive antiphospholipid antibodies (aPL). Due to its vascular nature, various organs and tissues may be affected, including the cardiac system. The cardiac involvement in APS is multifactorial: thrombosis plays an important role as well as immune-mediated injury. The most common manifestations include valve abnormalities, occlusive arterial disease, intracardiac emboli, ventricular dysfunction, and pulmonary hypertension. Many investigators favor a two-hit hypothesis to explain how aPL causes injury: the presence of aPL (first hit) induces endothelial injury and another condition (second hit), such as pregnancy, infection, trauma, surgery or malignancy, triggers thrombosis. The two-hit hypothesis may explain why patients persistently positive for aPL suffer thrombosis only occasionally. Aim: This article reviews cardiac involvement in APS, including criteria and non-criteria cardiac manifestations..Methods and Materials: The literature search was conducted through some online database, such is Pubmed, Sciencelib, Researchgate, Frontiers, Google Scholar, Willey online library. Key words for searching were used APS and atherosclerosis, APS and Cardiac manifestation, APS and myocardial infarction, Autoantibodies and atherosclerosis. Among 90 publications from high rated journals, were identified 33 relevant articles Published between 2002 and February 2021.Conclusion: As multiple traditional and nontraditional autoimmune-inflammatory risk factors initiate cardiovascular diseases (CVD) in APS, it is imperative to increase the efforts in early diagnosis, control risk factors and close follow-up, to minimize CVD development in APS. Hence multidisciplinary therapeutic approach has important role in these patients.