Abstract: Purpose: Cardiac involvement is not a common feature of the scleroderma, but may be important. The aim of this study was to find the frequency and the characteristics of cardiac involvement in sclroderma. Methods: Our cases were selected consecutively from 1997 to 1999, according to the American College of Rheumatology criteria. A complete cardiac examination (clinical, electrocardiography, chest X-ray, echocardiography, exercise test) was performed for all patients. These data were compared with a control group. Chi square and Fisher exact test were used for statistical analysis. Results: Sixty-seven Sclroderma patients (45 limited scleroderma, 22 diffuse from) and 83 control patients were evaluated. The mean age in the scleroderma group was 41.4+13 years and in the control group 34+12 years. The mean duration of the disease was 8.8+10 years. The following symptoms were seen more frequently in scleroderma (SCL) than in the Control group: Dyspnea 55% versus 17% (p=0.000006), peripheral edema 10% versus 0.7% (p=0.01), cardiac murmur 37% versus 4% (p=0.0000001), ST change 16% versus 0.7% (p=0.0006), right bundle branch block 7% versus 0% (p=0.01),left bundle branch block 9% versus 0% (p= 0.005), right axis deviation 9% versus 0.7% (p=0.003), cardiomegaly 22% versus 2% (p=0.0001), enlargement of pulmonary arc 15% versus 0% (p=0.0002), aorta insufficiency 6% versus 1.4% (p=0.005), tricuspid regurgitation 28% versus 0% (p=0.0000002), pericardial effusion 9% versus 0% (p=0.006), diastolic left ventricular dysfunction 21% versus 0.7% (p=0.00001). The exercise test was abnormal only in one patient. Conclusions: The main cause of cardiac manifestations was secondary to lung fibrosis. Primary cardiac involvement was uncommon.