Syphilitic heart disease in the elderly
Introduction
Introduction to syphilitic heart disease in the elderly Senile philic heart disease (senilesyphiliticheartdisease) refers to the syphilis spirochete into the outer layer of the aorta, leading to aortitis, aortic aneurysm, coronary aneurysm, coronary stenosis and aortic regurgitation, and cause corresponding clinical manifestations . basic knowledge The proportion of illness: 0.001% Susceptible people: the elderly Mode of transmission: sexual transmission, blood transmission Complications: angina pectoris heart failure aortic aneurysm
Cause
Elderly syphilitic heart disease
(1) Causes of the disease
The pathogen Treponema pallidum enters the human body through sexual contact through the damaged mucous membrane. It can enter the lymph nodes, liver, kidney, lung, heart, bone, joint, etc. through the lymphatic vessels in about 30 minutes, and some enter the aortic nutrient vessels through the pulmonary lymphatic vessels. Due to the increased lymphatic tissue of the ascending aorta, the lesions are located there. After 8 to 9 weeks of infection with syphilis, the spirochete is continuously increasing in the body, which can cause secondary lesions. About 30% of the patients who are not cured eventually cause cardiovascular and neurological changes. And the late stage syphilis of other organs, from the infection of syphilis to the occurrence of cardiovascular disease, the incubation period is 5 to 25 years, the disease is more men and women, 10% to 25% of cardiovascular syphilis and neurosyphilis coexist.
(two) pathogenesis
The ascending aorta is most frequently violated, followed by the aortic arch and descending aorta. The basic pathological change is the occluded endometritis of the affected artery or arterial nourishment angiogenesis, resulting in endometrial edema and scar formation, and lesions seen by the naked eye. The arterial intima is like a "eagle claw" or "twig" shape, which in turn causes aortic dilatation and aortic aneurysm. If the aortic annulus is dilated at the same time, it can cause aortic regurgitation.
The main manifestations of this disease are the following types:
1 uncomplicated syphilitic aortitis;
2 syphilitic aortic valve disease with aortic regurgitation;
3 syphilitic aortic aneurysm, can be seen in the ascending aorta, aortic arch or descending aorta, a small number of aortic sinus tumors, sometimes seen in the abdominal aorta;
4 syphilitic coronary stenosis or occlusion, patients may have refractory angina, but less myocardial infarction;
5 myocardial syphilis (gum-like swelling), generally rare, but may damage the conduction system, diffuse can lead to heart enlargement and heart failure, in all syphilitic cardiovascular disease patients, about 50% of people with syphilis Aortic inflammation, 1/3 to 1/2 of the simultaneous aortic regurgitation, a small number of syphilitic cardiovascular disease can be combined with coronary atherosclerosis.
Prevention
Elderly syphilitic heart disease prevention
Syphilis is a product of bad society and deafness activities, establishing new ethics, new fashion, prohibiting illegal sexual intercourse is a necessary measure to prevent the spread of syphilis, anti-drug and actively preventing the spread of AIDS, applying penicillin treatment to patients with early syphilis, and following up the serum test, necessary Repeat the treatment.
Complication
Elderly syphilitic heart disease complications Complications angina pectoris heart failure aortic aneurysm
Can be complicated by angina, heart failure, syphilitic aortic aneurysm and so on.
Symptom
Elderly syphilitic heart disease symptoms common symptoms dull pain systolic angina
According to the extent and influence of the lesion, the clinical manifestations can be divided into:
Simple syphilitic aortitis
(1) Symptoms: More than 80% of untreated patients develop syphilitic aortitis, most of which are asymptomatic, and some have post-sternal discomfort or dull pain.
(2) Signs: As the aorta expands, the dullness of the heart above the percussion is widened, and the second tone of the aortic valve area is enhanced, and mild systolic murmurs can be heard.
2. Syphilitic aortic regurgitation
It is the most common complication of syphilitic aortitis, which occurs 20 to 30 years after infection with syphilis, and is more common in older men.
(1) Symptoms: mild can be asymptomatic, severe due to massive aortic valve regurgitation, combined with coronary stenosis, resulting in reduced coronary blood flow, and angina, and gradually appear left heart failure.
(2) Signs: the heart sounds the sound to the left to the left, the second intercostal space on the right edge of the sternum or the left sternal border of the third and fourth ribs can be heard and the systolic period of the systolic period and the diastolic whispering sound, to the right edge of the sternum The most common between the intercostals, due to the expansion of the aortic root, diastolic whirl in the second rib of the left sternal border and to the apex.
3. Syphilitic aortic stenosis or obstruction
Is the second common complication of syphilitic aortitis (20% to 26%), the lesion involving the opening of the coronary artery, the patient may have angina pectoris, often at night, and the attack time is longer, if the coronary artery is completely blocked, the patient Sudden death can occur.
4. syphilitic aortic aneurysm
For the direct invasion of the aorta by syphilis, the aneurysms in different parts oppress the corresponding surrounding organs and tissues to produce corresponding symptoms and signs.
5. Myocardial gelatinous swelling
Extremely rare, clinical manifestations are non-specific and often diagnosed after death.
Examine
Examination of syphilitic heart disease in the elderly
Serological examination: syphilis serology ranges from lower specificity, sensitivity to high specificity, and sensitivity mainly includes the following methods.
1. Non-helical serum test (non-specific cardiolipin antibody)
There are VDRL test (venereal disease research laboratory), RPR (rapid plasmin cyclic card test) and AFT (automatic responsive) test, USR (unheated serum reagin) test, Often used for syphilis screening, the VDRL test is simple, inexpensive, and easy to standardize. It is used for screening screening. The initial syphilis positive rate is 70%, the second stage syphilis is 99%, and the positive rate of late syphilis (including cardiovascular and neurosyphilis). 70%, if combined with HIV infection, the response of the initial and phase II syphilis tests can be delayed or reduced.
2. Treponema pallidum test
Including Treponema pallidium immobilization test (TPI test), fluorescent treponemal antibody absorption test (FTA-ABS test) and Tremella microhemagglutination test (MHA-TP) Positive, FTA-ABS test in the early stage of syphilis was 85%, in stage II syphilis was 100%, in the late stage syphilis was 98%, can be used as a test for syphilis diagnosis, as a positive test for cardiovascular and neurosyphilis, MHA The sensitivity of the -TP test in the initial syphilis is worse than the VDRL test and the FTA-ABS test. The positive rate of syphilis in the initial stage is only 50% to 60%, but in the phase II and late syphilis in terms of sensitivity and specificity. The FFA-ABS test is similar, and the FTA-ABS test remains positive for life even after the patient is treated.
3. Treponema IgG antibody assay (Western blot test)
It has the characteristics of FTA-ABS test, 99% sensitivity and 88% specificity, easy to operate, especially for cases suspected of repeated infection, congenital syphilis and syphilis mixed with HIV.
4. Wassermann's test, Kahn's test Previously used in serological tests for syphilis, it has been replaced by the more sensitive and more specific methods described above.
Chest X-ray examination
In the simple syphilitic aortitis, the proximal aortic dilatation can be seen. About 20% of patients have clue calcification in the ascending aorta, while aortic atherosclerosis often has massive cirrhosis in the descending aorta. Often occurring several years after the occurrence of syphilitic aortitis, aortic and thoracic descending aorta can be calcified in syphilitic aortitis, but the ascending aorta is most calcified near the head and the brachial artery, and atherosclerosis The calcification of the aortic node and the thoracic descending aorta is most prominent when it is hardened. The syphilitic aortitis begins at the root of the aorta and can extend distally, up to the transverse sac, and the aorta of the lesion is widened. In the presence of aortic regurgitation, the heart enlarges to the left and the rear to form a shoe shape. Under the fluorescent screen, the heart and the aorta pulsate sharply, and the amplitude is large. In the aortic aneurysm, the aorta is bulged at the corresponding site and is inflated. Pulsation, ascending aorta or aortic archaplasia can erode bone destruction visible in adjacent bones, and there may be calcification in the tumor wall.
2. CT and MRI examination
CT (computed tomography) is a screening method for suspected cases of chest X-ray. It can accurately measure the size of an aneurysm. Its accuracy is no less than that of contrast-enhanced ultrasound and angiography. MRI (magnetic resonance imagine, Magnetic resonance imaging can obtain high-resolution static images, and has high diagnostic accuracy for thoracic aortic lesions. It can show cystic aneurysms, the true size and characteristics of aneurysms, the relationship with peripheral inflammatory reactions, and the extent of aneurysm involvement. The relationship with the aortic arch is highly sensitive and specific for the detection of valvular regurgitation.
3. Ultrasound examination
Echocardiography can show different segmental widening, calcification, aneurysm (including aortic sinus aneurysm) and aortic regurgitation, detection of aortic valve regurgitation by ultrasound Doppler, detection of left ventricular size, wall thickness, left End-systolic and end-diastolic pressure and volume, ejection fraction, etc., showing mitral valve abnormalities including anterior diastolic flutter, showing aneurysm size, location, and rupture.
4. Cardioangiography
Retrograde aortic angiography showed aortic aneurysm location and size, degree of aortic regurgitation, left ventricular size, cardiac function, etc. Selective coronary angiography for syphilitic cardiovascular disease patients with angina and suspected coronary stenosis At the time, the coronary artery stenosis is limited to the opening, and the distant coronary artery has no stenosis. This is different from coronary atherosclerosis. According to statistics, 20% to 80% of syphilitic aortitis patients have coronary ostia. narrow.
Diagnosis
Diagnosis and diagnosis of syphilitic heart disease in the elderly
Patients with syphilitic heart disease have a history of treatment, with typical syphilis or advanced syphilis clinical manifestations, positive syphilis serological response, diagnosis is not difficult.
There are two basic types of serological tests for syphilis, including the reaction with normal animal tissues such as beef heart cardiolipin and the establishment of non-specific lipidoid antigen responses in spirochetes. Tests, such as Wassermann complement fixation test, Kahn precipitation test, Hinton floc test, VDRL and Kolnier test, etc., other diseases such as systemic lupus erythematosus and infectious mononuclear except syphilis Hyperplasia can also present a positive serum response, which should be noted for identification.
Cerebrospinal fluid examination should be performed in all elderly patients with suspected syphilitic cardiovascular disease. About one-third of patients with syphilitic cardiovascular disease have signs of central nervous system involvement.
Clinically, the ascending aorta or aortic arch localized widening or calcification pays more attention to the exclusion of aneurysms caused by atherosclerosis. The syphilitic aortic lesions can also be seen at the beginning of the ascending aorta, while the general aortic atheroma When hardened, calcification is common in the aortic arch.
The syphilitic aortic regurgitation needs to be differentiated from rheumatic, arteriosclerotic or other causes of aortic regurgitation. The general onset of rheumatism is milder, and its murmur is enhanced in the late stage of contraction, often accompanied by biceps. Changes in the murmur and heart sound of the valve lesion, or mitral valve open sound, less angina, and the course of disease is longer than syphilitic, caused by aortic atherosclerosis, the aorta often has a wider expansion, simple Sexual aortic regurgitation can also occur in Marfan syndrome, rheumatoid arthritis, congenital bicuspid aortic valve, etc., should be noted.
