Syphilitic Heart Disease

Snapshot

• A 40-year-old woman presents to her primary care physician for a wellness exam. She currently does not have any acute concerns and reports to feeling well. She has not seen a physician in 20 years but presents today to be tested for sexually transmitted infections at the request of her new partner. She says she may have had a vaginal sore about 17 years ago. She had many sexual partners and infrequently uses condoms. On physical exam, cardiac auscultation is significant for a tambour-like quality S2 heart sound along with a diastolic decrescendo murmur in the left sternal border. A chest radiograph demonstrates calcifications of the ascending aortic arch.

Introduction

• Clinical definition
  • a cardiac complication of tertiary syphilis, where the vasa vasorum becomes impaired
    • this leads to ischemic injury to the aortic media
• Pathogenesis
  • believed to be caused by a vasculitis (obliterative endarteritis) of the vasa vasorum, which in turn, weakens the aortic root wall, leading to 
    • aortic dilation
• aortic valve regurgitation

Imaging

• Radiography of the chest
  • findings
    • calcification of the ascending aortic arch (usually)
      • this reflects intimal inflammation