Acute coronary syndrome of very unusual etiology
Raimundo Barbosa-Barros1, Andrés R Pérez-Riera2, Kimmo Koivula3
1Coronary Center of the Messejana's Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil.
Insights
Tertiary syphilis can cause aortitis, leading to coronary artery narrowing and symptoms mimicking acute coronary syndrome. Early diagnosis and penicillin treatment are crucial for managing this rare cardiovascular complication.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Syphilology
Background:
- Tertiary syphilis is a late stage of syphilis infection that can affect various organ systems.
- Cardiovascular syphilis, particularly syphilitic aortitis, is a serious complication, often presenting with aortic root dilation, aneurysm, or regurgitation.
- Coronary ostial stenosis, a less common manifestation, can lead to myocardial ischemia.
Observation:
- A 40-year-old male presented with unstable angina, lacking typical coronary artery disease risk factors.
- Electrocardiogram showed ST segment depression, and coronary angiography revealed critical ostial stenosis of the right and left main coronary arteries.
- Cardiac-computed tomography demonstrated aortic wall thickening involving bilateral coronary ostia.
Findings:
- The patient's presentation was attributed to syphilitic aortitis causing coronary ostial stenosis.
- Laboratory tests confirmed a strong syphilitic infection.
- The patient underwent coronary bypass surgery and received appropriate penicillin therapy.
Implications:
- This case highlights the importance of considering tertiary syphilis in the differential diagnosis of acute coronary syndrome, especially in patients without traditional risk factors.
- Prompt diagnosis and treatment of syphilitic aortitis are essential to prevent severe cardiovascular complications.
- Syphilitic aortitis requires a multidisciplinary approach involving cardiology, cardiac surgery, and infectious disease specialists.
Abstract:
Aortitis is one of many possible manifestations of tertiary syphilis. Aortic disease is the most common of all cardiovascular syphilitic lesions. Aortic diseases caused by tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation and coronary ostial stenosis. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 40-year-old male patient admitted with a clinical picture of acute coronary syndrome (unstable angina). He had no risk factors for coronary artery disease. The physical examination revealed nothing remarkable. The admission electrocardiogram (ECG) showed ST segment depression in the anterolateral and inferior leads (Figure 1). The coronary angiogram showed critical ostial stenosis of the right (RCA) and left main coronary artery (Figure 2a, b). Cardiac-computed tomography showed aortic wall thickening with involvement of bilateral coronary ostia (Figure 2b, c). The patient was referred for coronary bypass surgery after treatment with two doses of penicillin G. The laboratory test was strongly positive for syphilitic infection. Postoperative treatment with benzathine penicillin, in doses recommended for tertiary syphilis, was implemented.
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Maximum unusual value =...