Other Syphilitic Affection Of The Cardiovascular System
Aneurysm Of Aorta
The manifestations of syphilitic cardiovascular disease are seen in the tertiary stage. These include aortitis, aortic insufficiency, aneurysm or aorta, coronary ostial stenosis, gumma of the myocardium and syphilitic endarteritis.
Aneurysm Of Aorta
This is a late complication of syphilis which occurs from 15-30 years after primary infection. Aortitis may lead to a generalized dilatation and fusiform aneurysm or a localized dilatation to form saccular aneurysm. As aortitis most freqhently involves the ascending aorta, more than 50% of aneurysms also occur in this location.
Symptoms and signs of aneurysm arise from compression of adjacent structures. Ascending aortic aneurysms compress the pulmonary artery, superior vena cava or right main bronchus. Aneurysms of the arch compress the Esophagus, Trachea, bronchus, recurrent laryngeal nerve, sympathetic nerves and vertebrae. These lead to dysphagia, dypsnea, stridor, cough, hoarseness of voice, Horner’s syndrome and pain over the vertebra. An interesting physical sign in aneurysm of the arch is the tracheal tug, which is a tugging sensation felt when the neck is extended and larynx is held up.
Aneurysms of the descending aorta compress the lungs, erode vertebrae or ribs, and impinge on nerve roots. Descending thoracic or abdominal aortic aneurysms may present as pulsatile or nonspulsatile masses. Aneurysms may rupture into bronchus, pulmonary artery, pleura, pericardium or esophagus leading to fetal hemorrhage. Once symptomatic, the life expectancy for a patient with syphilitic aneurysms is only a few months. Antisyphilitic therapy should be followed up by surgery to resect the aneurysm without delay.
Other Clinical Manifestations
Coronary Ostial Stenosis
In syphilitic aortitis occlusion of the coronary opening is a slow process and therefore, acute myocardial infarction is rare. Osteal stenosis is often associated with AR. Diagnosis is made by aortic root angiography and coronary arteriography. Angina and suddent death due to arrhythmia may occur. Coronary artery hypass graft may be required after antisyphilitic thereapy.
They may produce bundle branch block or A-V block or electrocardiographic pattern of myocardial infarct. Antemortem diagnosis is extremely difficult.
© 2014 Funom Theophilus Makama