Drbeen Study Tip: Syphilis is an extremely important topic for all board and NBME examinations. As far as the cardiovascular lesions are concerned, 10-15% are late syphilitic lesions which are often progressive, disabling and even fatal.
Involvement usually starts as an arteritis in the supra cardiac portion of the aorta and progresses to the following:
narrowing of coronary ostia; resulting in decreased coronary circulation
angina and acute myocardial infarction
scarring of the aortic valves; producing aortic regurgitation and eventually Congestive Heart Failure
weakness of the wall of the aorta with saccular aneurysm formation.
Note: There are associated pressure symptoms of dysphagia, hoarseness, brassy cough, back pain (vertebral erosion is characteristic) and occasionally rupture of the aneurysm. Recurrent respiratory infections are common as a result of pressure on the trachea and bronchi.
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