Abstract Body (Do not enter title and authors here): Background: Cardiac involvement in rare genetic syndromes frequently determines long-term prognosis yet remains inadequately characterized in clinical practice. Current management approaches fail to address the unique cardiovascular risks present in these complex patient populations.

Methods: We analyzed 15 cases with rare genetic syndromes and significant cardiac involvement managed at a specialized genetics-cardiology clinic between 2021-2024. The cohort included Fabry disease in four patients, muscular dystrophy variants in three cases, Friedreich ataxia in three patients, and other rare conditions in five cases.

Results: Cardiac manifestations demonstrated syndrome-specific patterns with distinct prognostic implications. Fabry disease patients exhibited severe left ventricular hypertrophy averaging 19.3 ± 3.2 millimeters with three patients developing ventricular arrhythmias requiring device therapy. Muscular dystrophy variants showed predominant conduction system involvement with all three patients progressing to advanced atrioventricular block requiring permanent pacing within 24 months of presentation. Friedreich ataxia patients demonstrated rapid cardiomyopathy progression with mean annual ejection fraction decline of 18% despite optimal medical management. Two patients required advanced heart failure interventions including mechanical circulatory support evaluation. Specialized multidisciplinary care coordination reduced major cardiac events by 53% compared to historical controls through early intervention protocols and enhanced monitoring strategies. Genetic counseling services enabled family planning discussions and cascade screening initiatives in 80% of cases, identifying additional at-risk relatives requiring cardiac surveillance.

Conclusions: Systematic cardiac evaluation and specialized multidisciplinary management significantly improve clinical outcomes in patients with rare genetic syndromes and prevent cardiovascular complications through early intervention strategies.