Syphilitic Heart Disease

Baljinder SinghMs. TranTPJ 3M0November 12th, 2010

Historical Background• Syphilitic Heart Disease is a long term result of the STI

Syphilis• Syphil – itic = belonging to Syphilis• It is believed by scientists that Syphilis was present before

Europeans first came to North America• Name is derived from Greek term that means “coiled hair”

which represents the shape of the bacteria that causes disease

Basics

Description & Cause• A result of the involvement of the cardiovascular

system by the Treponema Pallidum• Treponema Pallidum is a species of spirochaete

bacterium• Spirochaete Bacterium are small single-cell

organisms/bacteria, and can be fatal by causing infections

• These bacteria result in syphilis and other diseases• Syphilis is a STD and if left untreated leads to damage

in the heart, brain, eyes, bones and more• Some signs of this disease include inflammation of the aorta, narrowing of the mouths coronary arteries, and dilation of the aorta

General Prevention• Primary: Safe-sex, Penicilin (antibiotic) and/or Azithromycin• Secondary: Early Diagnosis, treatment, and notification of

sexual contacts

Epidemiology• Epidemiology is the study of patterns of health and illness

at population level• Transmission of this disease usually happens through

sexual contact, contact with active lesion, blood transfusion and more

• This disease most common in 15-30 year olds• Mostly found in developing countries and Eastern Europe

• 12.2 Million new cases per year worldwide• In the US, fewer than 4 cases per 100,000 people• Prevalence much higher in African Americans• High incidence in 1970s and 1980s and most cases

associated with unprotected homosexual sex• Total of 31,575 cases in US in 2000, down from 575, 593

cases in 1943

Epidemiology Continued

Pathophysiology• Pathophysiology = what the disease actually does• The Spirochete Bacterium penetrates mucocutaneous

tissues• Enters the blood stream and then scatters everywhere in a

matter of days• Syphilitic Heart Disease is classified by progressive stages;• Incubation, Primary, Secondary, Latent, & Tertiary/Late• The invasion of the blood vessels causes occlusion of the

blood vessels • Resulting in injury to the arteries of the left side of the

heart that supply blood to all limbs through other arteries• The left side artery is the Aorta which is the biggest artery

in the human body

Diagnosis

Symptoms• Primary: - Chancre (a dull, red, insensitive wound) - Inguinal Lymphadenopathy (swelling near groin region)• Secondary: - Fever, Headache, Weight Loss - Rashes which lead to elevation of skin (papular) over

time - Myocarditis (inflammation of heart muscle)

Tests• Lab: - All patients with Syphilitic Heart Disease should have a

Cerebrospinal Fluid Examination (CSF) - Dark field microscopic examination of the fluid from

Chancre - Blood test to check for Syphilis in blood• Imaging: - Chest X-Ray (cardiac enlargement to look for matter in

the tissues) - Electrocardiogram (ECG) looks for inflammation in the

heart muscle• Cardiac Catheterization: - the insertion of a tube into a chamber of the heart to

look for signs of the disease

Scenario• Bill is a hard working college student and spends most of

his time studying. One day he wakes up and feels a heavy headache and fever. All of a sudden he feels really itchy all over his body, so he decides to go to the hospital. He has various tests and doctors tell him to wait while they examine his tests. What do you think? Does Bill have Syphilitic Heart Disease?

Scenario #2• Bob is a college student and loves to go out and party. He

sleeps with a different girl every weekend. Eventually Bob feels itchy in his groin area, but doesn’t pay much attention to it. One day Bob wakes up with a heavy headache and feels dizzy. He gets up but feels really weak and warm so he falls back in bed. All of a sudden he feels itchy all over his body including the groin region and when he lifts his shirt he notices red bumps over his body and notices rashes over his body. Bob rushes to the hospital for a check up and tests show that Bob has inflammation his heart. Bob is told to wait while doctors look for the disease if there is any. What do you think? Does Bob have Syphilitic Heart Disease?

Treatment

• Penicillin is preferred for all stages and is effective at early stages

• Penicillin is an antibiotic so it works to kill the bacteria• This works for all types of syphilis including Syphilitic Heart

Disease• Azithromycin, Doxycycline, and Tetracycline are also

options for patients allergic to Penicillin• Azithromycin – Intramuscular Injection • Doxycycline – Mouth/Throat Product• Tetracycline – Anti-infective agent

Medication

Surgery• Surgery may be considered• Surgical repair of blood-filled dilation due to weakness and

the disease• Surgery can also be done to remove tissue in the late

stages of the disease (very rare)

Ongoing Care

Prognosis

• Prognosis is the likely outcome of the disease• High chances of successful cure at early stages• Good prognosis with right treatmentComplicatio

ns• Heart Failure may be possible• The dilate filled blood vessels may also fail resulting in

sudden death

Reference List• Sommerville, Robert. Health and Wellness Library. Time Life Books.

2007.• Syphilitic Heart Disease. April 2010. 5 Minute Consult. November 7th,

2010. <http://5minuteconsult.com/5mc/405266> • Syphilis. 2010. T.J. Clark. November 9th, 2010.

<http://www.tjclarkinc.com/bacterial_diseases/syphilis.htm>