Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction and Death

These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.

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“…Rarely, the coronary ostia may become involved and saccular aneurysms may develop. 31 Neurological disease…”

Section: Cardiovascular Diseasementioning

confidence: 99%

UK national guidelines on the management of syphilis 2015

Kingston¹,

et al. 2015

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“…Tertiary syphilis, with cardiovascular manifestation, classically dilates the ascending aorta and causes aortic valve regurgitation due to plasmacytic vasculitis involving the vasa vasorum in the adventitia. In atherosclerotic disease, the inflammation of the arterial wall is seen in the media and surrounds the atheromatous plaque 7 , 8…”

Section: Discussionmentioning

confidence: 99%

Rupture of an ascending aortic aneurysm as a cause of sudden death

Freitas¹,

Petrini²,

Araujo³

et al. 2016

ACR

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An 84-year-old female patient was brought to the emergency department in cardiac arrest. Cardiopulmonary resuscitation maneuvers were performed but were unsuccessful. The patient had a past medical history of systemic arterial hypertension with target-organ lesions, including stroke and myocardial infarction. The autopsy was carried out, and the most striking finding was cardiac tamponade due to the rupture of an ascending aortic aneurysm at the site of a complex atheromatous plaque. Rupture is the most serious complication of a thoracic aneurysm and must be considered in the differential diagnosis of sudden death.

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“…In none of the cases syphilitic aortitis was diagnosed. Coronary ostial lesion can be seen in as many as 26% of the patients with syphilitic aortitis, however, it is uncommon for such ostial lesion to lead to acute myocardial infarction [3,8,9]. Patients with bilateral coronary ostial lesion but no distal coronary artery disease and those with ascending aorta aneurysms should be screened for syphilis.…”

Section: Discussionmentioning

confidence: 99%

“…Syphilitic aortitis and especially coronary artery ostial lesions with a normal distal bed are infrequently manifestations seen currently [2]. Ostial lesions uncommonly cause acute myocardial infarct [3]. Although cardiovascular syphilis is not a common condition, it should be considered in cases of ostial lesions alone.…”

Section: Introductionmentioning

confidence: 99%