Cardiovascular syphilis occurs in about 10% cases of syphilis. It causes arteritis—syphilitic aortitis and cerebral arteritis. One of the major complications of syphilitic aortitis is syphilitic or luetic aneurysm that develops in the tertiary stage of syphilis. It usually manifests after the age of 50 years and is more common in men. The predominant site of involvement is the thoracic aorta, especially in the ascending part and arch of aorta. It may extend proximally into the aortic valve causing aortic incompliance and may lead to syphilitic heart disease. Less often, it may extend distally to involve abdominal aorta.
PATHOGENESIS. -:About 40% cases of syphilitic aortitis develop syphilitic aneurysms. The process begins fromi infiltrate around the vasa vasorum of the adventitia, followed by endarteritis obliterans. This results in ischaemic injury to the media causing destruction of the smooth muscle and elastic tissue of the media and scarring.
Since syphilitic aortitis involves the proximal aorta maximally, aortic aneurysm is found most frequently in the ascending aorta and in the aortic arch.
EFFECTS.-: The clinical manifestations are found much more frequently in syphilitic aneurysms than in atherosclerotic aneurysms. The effects include the following:
1. Rupture.
Syphilitic aneurysm is likely to rupture causing massive and fatal haemorrhage into the pleural cavity, pericardial sac, trachea and oesophagus.
2. Compression.
The aneurysm may press on the adjacent
tissues and cause symptoms such as on trachea causing dyspnoea on oesophagus causing dysphagia, on recurrent
laryngeal nerve leading to hoarseness; and erosion of vertebrae, sternum and ribs due to persistent pressure.
3. Cardiac dysfunction.
When the aortic root and valve are involved, syphilitic aneurysm produces aortic incompetence and cardiac failure. Narrowing of the coronary ostia may
further aggravate cardiac disease.
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