Cardiovascular Syphilis - An Overview

Introduction

Syphilis is an STD or sexually transmitted disease. It may pose some critical health issues if not diagnosed and treated. Syphilis is a bacterial infection, does not spread at once. Instead, there are four stages of syphilis. Every scene has its own predominant signs and symptoms. Cardiovascular syphilis is generally observed in the third stage of syphilis and only after 10 to 40 years post contracting syphilis. Cardiovascular syphilis affects the heart and the entire circulatory system by manifesting an array of cardiac conditions. The heart is divided into four chambers- right and left upper chambers called atrium and right and left lower chambers called ventricles. Cardiovascular syphilis generally tends to complicate the functions starting from the heart's upper chambers. Syphilis, which is caused due to a microorganism called Treponema pallidum, poses a risk to the heart and alters the normal functioning of the brain, eyes, muscles, and other vital organs.

What Are the Stages of Cardiovascular Syphilis?

Syphilis occurs when there is sexual contact that is unprotected, or there is a sexual relationship between men. Syphilis is widespread in the initial stages of its contraction and thus affects the whole body slowly but surely. Regarding the cardiovascular system, it inflames all the cardiac muscles temporarily. This transient swelling does not cause any harm to the circulation initially. When syphilis is deeply involved in the cardiac system, it comes in the way of the regular functioning of the heart, especially the aorta and the aortic valve. Aorta is the largest artery of the heart as well as the entire body. It is the main supply of oxygen-rich blood to the circulatory system. In later stages, the heart may get enlarged due to dilation and aortic insufficiency. As a result, the coronary circulation is hampered, which may result in cardiac arrest or extreme chest pain. Parts of the heart muscles start to die in the last stage of syphilis and thus may lead to heart failure.

What Are the Signs and Symptoms of Cardiovascular Syphilis?

Cardiovascular syphilis affects the aortic valves, which eventually makes the aorta lose the elastic properties that help it strong gushes out of the blood. The aorta may also rupture. Below are the clinical manifestations of cardiovascular syphilis. It should be noted that there are several cases of cardiovascular syphilis that are asymptomatic in nature. Thus the healthcare provider must be aware of all the aspects, including symptomatic and non-symptomatic syphilis.

• Blunt heart sounds.

• Troubled heart murmurs.

• Mild increase in cholesterol levels.

• Tightness of the chest.

• Abdominal discomfort.

• Dilation of the aortic ring.

• Chest pain.

• Difficulty in breathing.

• The incompetence of the aortic valve.

• Hypertrophy of the left ventricles (an enlargement or thickening of the muscle walls of the left ventricle, the main pumping chamber of the heart).

• Aortic root dilation (enlargement or widening of the initial section of the aorta).

• Coronary artery ostia (openings of the coronary arteries, which are responsible for supplying oxygenated blood to the heart muscle).

• Stenosis of the coronary arteries (constriction of the coronary arteries).

• Aneurysm (abnormal bulging or ballooning of a blood vessel).

• Endarteritis (inflammation of the inner lining of an artery).

• Periarteritis (inflammation of the tissue surrounding an artery).

• Aortic regurgitation (condition where the aortic valve does not close properly).

• Coronary occlusion (complete obstruction of a coronary artery).

• Myocardial infarction (heart attack).

• Episodes of a heart attack.

• Shortness of breath.

• Mucinous myocarditis (inflammation of the heart muscle with the presence of mucin).

• Aortitis (inflammation of the aorta).

• Thickening of the aortic wall.

How to Diagnose Cardiovascular Syphilis?

Detection of syphilis is not done routinely in the early stages of acquiring the disease. This is one of the main reasons that lead to the development of cardiovascular syphilis in the third or the tertiary stage of infection. A serologic test, a histologic examination, and a detailed history of sexual contact with the patient are a must to correctly end up in the diagnosis. A radiological diagnostic tool of choice is a computed tomography or CT scan since it helps visualize the heart's size and anatomy. At times it can also be of use to rule out the manifestations of aortic regurgitations as well as lesions in the aorta that hamper the smooth flow of blood from the heart to the entire body.

• Coronary angiography.

• Echocardiography.

• Chest x-ray.

• Direct fluorescent antibody tests.

• Polymerase chain reaction test.

• Electrocardiography.

• Venereal disease research laboratory test.

• Rapid plasma reagin test.

• Rapid immunochromatographic test.

• Enzyme immunoassay test.

• Fluorescent treponemal antibody absorption test.

• Treponema pallidum particle agglutination assay.

• Darkfield microscopy.

• Microhemagglutination assay.

• Cardiac magnetic resonance imaging.

• A complete blood picture.

• Cerebrospinal fluid tests.

How Is Cardiovascular Syphilis Treated?

If syphilis is diagnosed in the early stages, the treatment modality is quite simple, and the cure is fast too. Nevertheless, from the initial to the fourth stage of syphilis, antibiotic medication is the therapy of choice with Penicillin administration. If the patient is sensitive to Penicillin, the professional suggests another similar antibiotic treatment. Before going into a surgical stage of treatment, the potential of large doses of Penicillin and Doxycycline, as well as a combination of other antibiotics, should be thoroughly discussed. This requires a multidisciplinary approach. Treatment of cardiovascular events should be treated accordingly by bringing a team of cardiologists into the picture. The main aim of the treatment will be to not lead the heart to cardiac failure or acute myocardial infarction. In case the patient's condition is severe, a heart transplant may also be a choice of management to ponder upon.

Conclusion

Syphilis is a sexually transmitted disease occurring in men having sexual relations with men. The bacterial illness flourishes throughout the body, affecting almost every part but in four stages. The circulatory and cardiovascular systems come under their prey in the third stage. Cardiovascular syphilis that appears in the third stage of syphilis infection leads to aortitis, aortic aneurysm, coronary stenosis, aortic insufficiency, and myocarditis. The healthcare provider and team must be aware of the clinical manifestations and must have a well-planned strategy for diagnosis and evaluation of the presence of cardiovascular syphilis. The patient should be treated with Penicillin, Doxycycline, and other antibiotics. Additionally, an interdisciplinary approach should also decide whether to intervene surgically or not. Syphilis in the third stage presenting cardiovascular syphilis can be avoided by the correct line of treatment as well as early diagnosis of syphilis when contracted in the first stage.