Syphilitic Heart Disease

1. Syphilitic Heart Disease Baljinder Singh Ms. Tran TPJ 3M0 November 12th, 2010

2. Historical Background • Syphilitic Heart Disease is a long term result of the STI Syphilis • Syphil – itic = belonging to Syphilis • It is believed by scientists that Syphilis was present before Europeans first came to North America • Name is derived from Greek term that means “coiled hair” which represents the shape of the bacteria that causes disease

3. Basics

4. Description & Cause • A result of the involvement of the cardiovascular system by the TreponemaPallidum • TreponemaPallidum is a species of spirochaete bacterium • Spirochaete Bacterium are small single-cell organisms/bacteria, and can be fatal by causing infections • These bacteria result in syphilis and other diseases • Syphilis is a STD and if left untreated leads to damage in the heart, brain, eyes, bones and more • Some signs of this disease include inflammation of the aorta, narrowing of the mouths coronary arteries, and dilation of the aorta

5. General Prevention • Primary: Safe-sex, Penicilin (antibiotic) and/or Azithromycin • Secondary: Early Diagnosis, treatment, and notification of sexual contacts

6. Epidemiology • Epidemiology is the study of patterns of health and illness at population level • Transmission of this disease usually happens through sexual contact, contact with active lesion, blood transfusion and more • This disease most common in 15-30 year olds • Mostly found in developing countries and Eastern Europe

7. Epidemiology Continued • 12.2 Million new cases per year worldwide • In the US, fewer than 4 cases per 100,000 people • Prevalence much higher in African Americans • High incidence in 1970s and 1980s and most cases associated with unprotected homosexual sex • Total of 31,575 cases in US in 2000, down from 575, 593 cases in 1943

8. Pathophysiology • Pathophysiology = what the disease actually does • The Spirochete Bacterium penetrates mucocutaneous tissues • Enters the blood stream and then scatters everywhere in a matter of days • Syphilitic Heart Disease is classified by progressive stages; • Incubation, Primary, Secondary, Latent, & Tertiary/Late • The invasion of the blood vessels causes occlusion of the blood vessels • Resulting in injury to the arteries of the left side of the heart that supply blood to all limbs through other arteries • The left side artery is the Aorta which is the biggest artery in the human body

9. Diagnosis

10. Symptoms • Primary: - Chancre (a dull, red, insensitive wound) - Inguinal Lymphadenopathy (swelling near groin region) • Secondary: - Fever, Headache, Weight Loss - Rashes which lead to elevation of skin (papular) over time - Myocarditis (inflammation of heart muscle)

11. Tests • Lab: - All patients with Syphilitic Heart Disease should have a Cerebrospinal Fluid Examination (CSF) - Dark field microscopic examination of the fluid from Chancre - Blood test to check for Syphilis in blood • Imaging: - Chest X-Ray (cardiac enlargement to look for matter in the tissues) -Electrocardiogram (ECG) looks for inflammation in the heart muscle • Cardiac Catheterization: - the insertion of a tube into a chamber of the heart to look for signs of the disease

12. Scenario • Bill is a hard working college student and spends most of his time studying. One day he wakes up and feels a heavy headache and fever. All of a sudden he feels really itchy all over his body, so he decides to go to the hospital. He has various tests and doctors tell him to wait while they examine his tests. What do you think? Does Bill have Syphilitic Heart Disease?

13. Scenario #2 • Bob is a college student and loves to go out and party. He sleeps with a different girl every weekend. Eventually Bob feels itchy in his groin area, but doesn’t pay much attention to it. One day Bob wakes up with a heavy headache and feels dizzy. He gets up but feels really weak and warm so he falls back in bed. All of a sudden he feels itchy all over his body including the groin region and when he lifts his shirt he notices red bumps over his body and notices rashes over his body. Bob rushes to the hospital for a check up and tests show that Bob has inflammation his heart. Bob is told to wait while doctors look for the disease if there is any. What do you think? Does Bob have Syphilitic Heart Disease?

14. Treatment

15. Medication • Penicillin is preferred for all stages and is effective at early stages • Penicillin is an antibiotic so it works to kill the bacteria • This works for all types of syphilis including Syphilitic Heart Disease • Azithromycin, Doxycycline, and Tetracycline are also options for patients allergic to Penicillin • Azithromycin – Intramuscular Injection • Doxycycline – Mouth/Throat Product • Tetracycline – Anti-infective agent

16. Surgery • Surgery may be considered • Surgical repair of blood-filled dilation due to weakness and the disease • Surgery can also be done to remove tissue in the late stages of the disease (very rare)

17. Ongoing Care

18. Prognosis • Prognosis is the likely outcome of the disease • High chances of successful cure at early stages • Good prognosis with right treatment Complications • Heart Failure may be possible • The dilate filled blood vessels may also fail resulting in sudden death

19. Reference List • Sommerville, Robert. Health and Wellness Library. Time Life Books. 2007. • Syphilitic Heart Disease. April 2010. 5 Minute Consult. November 7th, 2010. <http://5minuteconsult.com/5mc/405266> • Syphilis. 2010. T.J. Clark. November 9th, 2010. <http://www.tjclarkinc.com/bacterial_diseases/syphilis.htm>