Syphilitic cardiovascular disease

Outlined by the Department of Treponema pallidum into aortic adventitia trophoblast vascular cause chronic inflammation, vascular occlusion, Then aortic elastic middle layer of muscle fiber and necrosis, fibrosis, scar formation, resulting Yan aorta and aortic aneurysm, Coronary artery stenosis and aortic valve insufficiency and other diseases, the corresponding clinical manifestations. Also penetrated a few cases of myocardial. The disease acquired infection, the more infected after 10 -25 years before he appeared cardiovascular clinical symptoms and signs. Pathogenesis and pathology Treponema pallidum through local Tienam enter the body, after entering the lymphatic node and liver, spleen, heart, brain and other organs, due to the ascending aorta lymphoid tissue more spirochetes portion of the hilar lymph control, nurtured into aortic vascular adventitia and leads to chronic inflammation; Nutrition vascular endothelial cell proliferation and transparent degeneration, vessel occlusion, adventitial fibrosis artery, middle and elastic fibers of muscle damage, and a plasma cell infiltration and partial necrosis. Fiber aortic intima thickening, accompanied the late atherosclerosis. Lesions occur in the ascending aorta and aortic arch, light less involved descending thoracic aorta, carotid arteries and abdominal aorta, Yan syphilitic aortic intima or for a smooth bark-like folds, the majority of patients with aortic atherosclerosis. Because the tumor often involved ascending aortic root, will expand a bad aortic valve, aortic valve leaves separated junction, and the aortic valve insufficiency; Mr involvement aortic valve, the valve thickening, kink, make aortic insufficiency exacerbated, aortic elastic middle layer of muscle fiber necrosis and, The Department elastic artery wall disappear bulging outward, forming aortic aneurysms, aortic sinus lesions. aortic wall fibrosis can lead to coronary artery stenosis. Since coronary stenosis slow, it often collateral circulation, the less cause myocardial infarction, But angina still occur from time to time. Treponema pallidum very rarely penetrated the heart, Myocardial diseases mainly due to aortic valve insufficiency, or coronary artery stenosis caused myocardial hypertrophy or fibrosis. If accompanied by coronary atherosclerosis, and often can lead to myocardial infarction, myocardial degeneration gum extremely rare. Such lesions confined to the more septal left bundle-branch and the beam. Diffuse gum rare kind of change. According to clinical manifestations of cardiovascular lesions and their characteristics, clinical can be divided into the following five categories : 1. Simple syphilitic aortic disease (syphilitic aortitis) General symptomless, Occasionally minor chest discomfort, it is difficult to clinical early detection. Visibility investigation body aortic valve area hyperparathyroidism associated with the second heart sound mildly projectile systolic murmur. X-rays showed the ascending aorta local widened, expandable convex, aortic pulse contraction increased, sometimes in the aorta strips calcification. With aortic atherosclerosis, calcification occurs in the aortic arch, was massive. 2. syphilitic aortic insufficiency (syphilitic bifurcated egurgitation ) syphilitic infection of the heart general after 10 -25 years to produce symptoms and signs. Aortic insufficiency is the most common clinical type, in the case of aortic insufficiency, will be maintained 5 -6 years or more asymptomatic or only mildly alarmed and shortness of breath, or accompanied by angina, The latter often due to coronary artery stenosis. Once heart failure, the condition often rapid progress, recurrent pulmonary edema, a serious threat to life. Physical examination often left heart voiced sector expanded sternum right edge of the second and third intercostal voiced sector widened, apexcardiogram increase. Auscultation in the sternum right edge of the second and third intercostal sternum and the left edge of the third, 4 intercostal have projectile systolic and diastolic murmur quarrels can be left armpit conduction. Apical region can often hear the rumbling lesser sexual diastolic murmur. Because of this aortic insufficiency reflux impact are being opened to the mitral anterior leaflet, produced relative caused mitral stenosis. This murmur also said Austin-Flint murmur with rheumatic mitral stenosis is different. The former is not associated with the first heart sound apical area open valve hyperthyroidism or sound, nor systolic enhanced greatly. Aortic valve in the first, two areas auscultation heard projectile systolic murmur, mainly due to expansion of aorta, Early in the regular contraction enhancement; and rheumatic aortic stenosis and insufficiency noise generated more contraction in the late strengthened, accompanied neck or sternum right edge of the second intercostal systolic tremor. Aortic valve area hyperthyroidism second heart sounds, as the weakening or disappearance of aortic valve disease involving the extent to which. Inflammation involved only aortic valve, aortic valve area second heart sound hyperthyroidism; aortic valve lesions were fibrous or change activity weakened valve, aortic valve area second heart sound weakened or disappeared, apical region heart failure can hear diastolic Benma law. Aortic insufficiency heavier, sometimes accompanied by increased pulse pressure, peripheral arterial, there will be the shot noise, capillary and arterial pulse return murmur Department (Duroziez levy), peripheral vascular signs. X-ray examination showed cardiac under the left rear increased heart shoe was available, the limitations of the ascending aorta was expanding, ECG showed left ventricular hypertrophy, the Left Alliance have ST-segment depression and T-wave inversion. 3. syphilitic coronary stenosis (Stenosis of coronary Syphilitic O ística) often associated with aortic insufficiency also exist. Since coronary stenosis occurred slowly, often rich coronary collateral circulation; Therefore, Early patients with no obvious symptoms can be. Coronary artery stenosis occurred slowly, coronary stenosis severe angina may occur, Some of the patients developed symptoms died a short time later. The incidence of myocardial infarction lower, but with coronary atherosclerosis, myocardial infarction higher rate of incidence. 4. syphilitic aortic aneurysm (syphilitic bifurcated graft) syphilitic aortic aneurysm Because of its location different, with different clinical manifestations, clinical more common with the following types : (1) or aortic aneurysm known as signs of aortic aneurysm, or aortic aneurysm often forward, and the expansion of the upper right, in the course of aortic aneurysm can increase asymptomatic, although there are obvious signs, symptoms but still very significant. Ascending aortic aneurysm forward expansion may trigger sternum right edge of the first, two intercostal partial uplift and pulses; Aneurysms can be expanded oppression right superior vena cava and the emerging face, upper extremity edema and bruising, chest computed vein, compression of the right bronchus and right lung caused shortness of breath and copper sound like cough, often accompanied by pulmonary infection, Occasionally, the pulmonary artery pressure and pulmonary stenosis have the signs and symptoms. Ascending aortic aneurysm such as nerve compression, ribs or sternum, there will be chest pain. Enlargement of aneurysm rupture occurred, such as aneurysm ruptured into the pulmonary artery, there will be a similar patent ductus arteriosus continuity noises. If breaking into the pericardial cavity can occur in acute cardiac tamponade symptoms and signs of breaking into the chest of sudden death. (2) aortic arch aneurysms are called symptomatic aortic aneurysm. As the aortic arch aneurysm can occur early in the surrounding structure of oppression and developed symptoms. If aneurysms, there will be oppression esophageal dysphagia; Superior vena cava pressure appeared to her face, chest and upper extremity edema venous engorgement; Cong oppression, there will be sympathetic side Miosis and (or) the side of the skin and sweat-free; Left recurrent laryngeal nerve compression may appear hoarseness; phrenic nerve compression may appear belch inverse and chest pain. Left bronchial compression can cause asthma and copper-like cough, bronchial stenosis can occur atelectasis and repeated lung infections. Aneurysm to the chest as prominent, visible chest body check local uplift a beat. Heart no general expansion in ascending aortic aneurysm site systolic murmur can be heard. pulmonary venous pressure and azygos vein, there may be signs of pleural effusion. Aortic arch aneurysm rupture of a small number of patients also means a lot of hemoptysis trachea and died of suffocation. (3) Aortic Aneurysm three aortic sinus aneurysm can occur, the tumor grew up, convex into the heart, to gradually increase, oppression can be dealt near the right ventricular outflow tract obstruction and aortic valve insufficiency, atrioventricular block or coronary artery embolization. The tumor has not been broken, have no obvious symptoms may have heart palpitations, chest pain, angina, atrioventricular block or aortic insufficiency and right ventricular outflow tract obstruction symptoms and signs. Gradually thinning wall of the aneurysm can rupture into the right atrium, right ventricle; Pulmonary artery, left atrium, left ventricle, or pericardial cavity. With a right aortic sinus aneurysm ruptured into the right ventricle most common. Aneurysm ruptured into the pulmonary artery, the right ventricle or right atrium and the left edge of the third sternum. 4 intercostal continuity heard loud noises like machines can touch small tremor, increased heart voiced sector, arterial pressure can reduce diastolic blood pressure, pulse pressure, along with veins and capillaries of water will pulsate. (4) descending aortic aneurysms can be asymptomatic or early signs. Great aneurysm as oppression can lead to esophageal dysphagia, oppression, there will be the bronchial cough, short breath and repeated respiratory infections, oppression or thoracic ribs have severe chest pain, chest wall can be seen after the beating. (5) abdominal aortic aneurysm less see. Oppression spinal aneurysm or other organs can be sustained or paroxysmal abdominal pain. Check-in location of tumor can be touched beat accompanied by small tremor. 5. Myocardial syphilitic aneurysm (syphilitic gumma of LAD) mainly myocardial gum-like change, the more common diseases of the limitations in the left ventricular septal can no symptoms. If the tumor is located in the bundle or bundle branch spaces, ECG can be left bundle branch block, myocardial larger-swollen gums, can lead to false mitral stenosis, there will be corresponding symptoms and signs, diffuse kind of gum can change the heart increases markedly, ultimately occurred intractable heart failure.