Seronegative spondyloarthritis may be complicated by a variety of cardiac lesions including aortitis. We describe a patient with Reiter's syndrome who presented with angina and new onset heart murmurs. Cardiac catheterization revealed myocardial ischemia and aortic insufficiency. Our patient underwent bypass surgery with aortic valve replacement. Severe narrowing of the coronary ostia was noted and aortitis was documented by pathologic examination.