Cardiovascular syphilis is a late-stage syphilis that can only be diagnosed 10-30 years after infection. Usually it is diagnosed in people around 50 years of age. Cardiovascular syphilis is rare and, if left untreated, can lead to death. What are the symptoms of cardiovascular syphilis? What is the treatment?
Cardiovascular syphilisis tertiary syphilis, a late stage of the disease that appears more than 2 years after infection. The disease mainly affects the initial aorta and causes a variety of complications, including fatal ones. The diagnosis of syphilis should not be neglected, as the initial treatment eliminates the risk of the serious consequences of this disease. Once they do occur, treatment is complicated and much more complicated, including extensive surgery.
Cardiovascular syphilis - stages of syphilis development
Syphilis is a sexually transmitted systemic disease. The pale spirochete (LatinTreponema pallidum ) is responsible for the development of syphilis, which penetrates the body through damaged mucous membranes and skin, most often after sexual contact with a sick person. It causes ailments from many systems and its course is chronic. Among the long-term complications there are e.g. diseases of the cardiovascular system.
The course of syphilis is long, there are symptomatic and asymptomatic periods, and the disease picture varies greatly over time. Early syphilis lasts up to two years after infection. Initially, a painless "hard ulcer" appears in the genital area with a moist bottom containing the spirochetes. It is accompanied by enlargement of the lymph nodes. At this time, the disease is very contagious, but limited. The lesion wears off after approximately 9 weeks. This is followed by the spread of the bacteria through the bloodstream - this is the second period syphilis. The lymph nodes of the entire body are enlarged, and there is a macular rash distributed symmetrically throughout the body. It disappears without leaving scars, but has a tendency to recur - in this case papules and pustules appear much more often. At this time, there may also be changes in the genitals in the form of spots or papules.
The risk of infection largely depends on the duration of the disease as well as the presence of skin lesions.
Late tertiary syphilis is the next stage of the diseaseappearing more than 2 years after infection. During this time, all systems can be attacked, because in the second period the bacteria entered every organ with the flow of blood. Most often it is the nervous and cardiovascular systems and, of course, the skin on which ulcers form. Within the nervous system, it can cause meningitis and inflammation of the brain, as well as sensory disturbances and limb paralysis. Each of the periods of syphilis can take place in a latent manner, without any symptoms, and diagnosis is possible in this case only on the basis of laboratory tests. Fortunately, proper treatment slows down the progression of the disease and prevents complications, which is why it is so important to see a doctor immediately in the event of any suspicious skin changes and inform your partner if the disease is diagnosed.
Late cardiovascular syphilis
The diagnosis can be made only after the diagnosis of complications in the field of the cardiovascular system. The most common form is aortic inflammation, which accounts for approx. 80% of the disease. cases of tertiary syphilis. In this case, there is an inflammatory process and damage to the so-calledvasa vasorum , i.e. small vessels responsible for the vascularization of the aortic wall.
Cardiovascular syphilis is most often diagnosed 10-30 years after infection, usually in people around the age of 50.
They are necessary because the aortic wall is thick, the blood flow is very fast, so the cells are unable to absorb the necessary nutrients.Vasa vasorum , in Polish, vessels are designed to supply blood with oxygen and nutrients to all cells that build the main artery. Their role is so important that in the event of obliterating inflammation of these vessels - leading to their closure (which occurs in the course of syphilis) - the aorta loses its elasticity, scarifies, calcifies and distension occurs. Thus, aneurysms (pathological local dilatation of vessels) are formed in the initial aorta, most often in the ascending aorta, less frequently in the remaining parts of the thoracic aorta, which, interestingly, never occur in its abdominal part. However, they have many consequences, such as :
- shortness of breath - when the dilation is so large that it compresses the airways or lungs
- difficulty swallowing - if esophagus is pinched
- cough - this occurs when the nerve going to the larynx (the recurrent laryngeal nerve that wraps around the aortic arch is compressed)
- aortic regurgitation with all its symptoms,such as fatigue and loss of consciousness and the consequences, especially heart failure. This condition occurs when the aneurysm appears at the very beginning of the aorta and the aortic valve ring, which is the site of leaflet attachment, is dilated. Heart failure due to this disease is the most common cause of death in people suffering from this form of syphilis,
- ischemic heart disease, which occurs when an aneurysm compresses the coronary arteries
- aneurysm rupture and immediate death due to bleeding
Only aortic inflammation is possible, without an accompanying aneurysm and other sequelae. A very rare form of cardiovascular syphilis is occlusive cerebral arteritis, leading to strokes.
Cardiovascular syphilis - diagnosis. Laboratory and imaging tests
Depending on the phase of the disease, various laboratory tests are carried out, the so-called cardiolipin reactions at the onset of the disease and spirochetal reactions at a more advanced stage. Therefore, in late syphilis, FTA-ABS, i.e. the binding reaction of anti-treponemal antibodies, and TPHA, i.e. the hemagglutination test, are performed. Both of these tests are typical for syphilis and are only performed when the disease is suspected. Positive results confirm the diagnosis of tertiary syphilis, especially when the VDRL test is negative.
In terms of imaging diagnostics, aimed at cardiovascular complications of syphilis, complications-specific tests are performed, such as: echocardiography - it allows to diagnose and assess aortic valve regurgitation, widening of the initial aortic segment and the severity of heart failure, if any . In addition, X-rays, computed tomography and MRI of the chest are used to assess local complications of aortic aneurysm, such as pressure on the esophagus or airways, but also its size and evaluation before possible surgery.
In case of ischemic heart disease, typical tests for this diagnosis are performed - stress test and coronary angiography. Of course, apart from cardiological diagnostics, other possible complications of syphilis should be checked, especially neurological ones, including examination of the cerebrospinal fluid.
Cardiovascular syphilis - treatment
Treatment of cardiovascular syphilis is infection specific and specific to the system involved.
Treatment begins with the elimination of the spirochete from the body. Penicillin is used intramuscularly for quite a long time, about a month. After such therapy, it should be checked whether it was effective. Laboratory tests are performed - reactionsserological immediately after and for many years after the therapy.
In the case of vascular complications, the ailments resulting from the dysfunction of this system are treated. In the presence of an aortic aneurysm, which is likely to rupture, a cardiac surgery is performed with implantation of a vessel prosthesis. Depending on the condition of the aortic valve and coronary vessels, this operation may be extended to include valve repair or replacement, or by-pass implantation.
Treatment of impaired blood flow in the coronary vessels includes - apart from pharmacological treatment - also percutaneous coronary angioplasty. In the case of aortic regurgitation, percutaneous valve replacement, i.e. TAVI, is used.