We performed cardiac magnetic resonance imaging(CMRI) and autonomic function test(AFT) along with other institutional standard evaluation(Clinical examination including Myositis Diseases Activity Assessment Tool(MDAAT), Manual Muscle Testing–8(MMT8) and laboratory investigations including electrocardiography, echocardiography, antinuclear antibody  profile, paraneoplastic panel, myositis panel, creatinine-kinase, urine-myoglobin , rheumatoid-factor, and C-reactive protein and lactate dehydrogenase) among a prospective cohort of consecutive clinically diagnosed patients of IIM in the age group of 10-60years. Cases with pre-existing cardiac and autonomic disorders were excluded. 

Out of 14-patients, mean age was 37.42 ±12.64 years, with mean age of onset of symptoms of 36.28 ± 12.88years and presented within 12.14 months(SD±8.40) of onset of illness. Females were more commonly affected(sex ratio 6:1). Skin lesion, myalgia followed by limb and/or bulbar weakness were the most common presentation(6/14, 42.85%). Mean MDAAT and MMT8 were 27.71±7.37 and 56.78 ±11.40 respectively. 13-patients(92.85%) had either myositis specific or myositis associated antibody positivity. 11 patients(78.57%) had more than one antibody positivity. Most common were anti-Mi2ß (42.85%) followed by anti-Mi2a(28.57%),anti-SRP(28.57%) and anti-Ro52 antibody(28.57%). Cardiac symptoms are reported in 3/14(21.42%),whereas CMRI-based Cardiac abnormalities were reported in 6/13(46.15%). ECG showed sinus-tachycardia in 4/14(28.57%). Autonomic symptoms were present in 5/14(35.71%) whereas AFT-based dysautonomia was diagnosed in 80%. Cardiac involvements was reported frequently in Anti-Scl(100%),anti-SRP(50%),anti-Ro52(50%),anti-TIF-1?(50%),Mi2a(25%) and Mi2β(16%). 

The study highlights the involvement of cardia in conjunction with dysautonomia in IIM . It is essential for the neurologists to be aware of this association and formulate appropriate early diagnostic and management strategies while treating these patients.