Cardiac involvement in 27 consecutive patients fulfilling the criteria for primary Sjögren's syndrome was evaluated using echo-doppler-cardiography. A clinical physical examination showed that the heart was normal in all patients. Nine (33%) had signs of present or previous pericarditis with effusion and/or fibrin deposition, four of them had chest symptoms. The pericarditis patients were slightly older, had significantly shorter disease duration, had significantly increased levels of orosomucoid and haptoglobin, and were significantly more often antinuclear-antibody positive than those without pericarditis. Of the echocardiographic measurements, the left ventricular systolic dimension was significantly smaller and the fractional shortening of the left ventricle significantly higher in the pericarditis patients. However, four of the nine pericarditis patients had localized hypokinesia of the left ventricle, all with unspecific ECG changes, while only one without pericarditis showed this symptom. No patient had low voltage, ST-T elevation or conduction abnormalities. Mitral valvular thickening was found in one patient and age-related sclerosis of the aortic cusps appeared in some.