Cardiovascular syphilis-associated acute myocardial infarction: A case report
Xiangdong Li1, Xue Wang1, Zhiyuan Wang2
1Department Of Cardiology.
Insights
Advanced syphilis can cause severe cardiovascular complications like myocardial infarction. This case highlights successful treatment using extracorporeal membrane oxygenation (ECMO)-assisted percutaneous coronary intervention (PCI) followed by penicillin for syphilis.
Area of Science:
- Cardiology
- Infectious Diseases
- Vascular Surgery
Background:
- Advanced syphilis, though declining, can lead to severe cardiovascular manifestations including aortitis, valve insufficiency, and myocardial infarction.
- Syphilis can affect the aorta, leading to coronary ostium stenosis and myocardial infarction, often diagnosed late due to lack of initial treatment.
Observation:
- A 48-year-old woman with a history of untreated syphilis presented with chest tightness and was diagnosed with myocardial infarction.
- Coronary angiography revealed stenosis at the right coronary artery ostium and left main ostium.
Findings:
- The patient underwent successful percutaneous coronary intervention (PCI) with drug-eluting stents, assisted by extracorporeal membrane oxygenation (ECMO) technology.
- Post-intervention, the patient received penicillin for syphilis and showed gradual improvement in cardiac function and left ventricular ejection fraction with optimized drug therapy.
Implications:
- ECMO-assisted PCI effectively treated coronary ostium stenosis in this advanced syphilis case, reducing surgical risk.
- Early diagnosis and standard antibiotic treatment for syphilis are crucial to prevent severe cardiovascular complications; this case provides a reference for managing similar complex cases.
Rationale:
In recent decades, the incidence of advanced syphilis has declined due to early recognition and the application of effective antibiotics. Advanced syphilis often manifests in the cardiovascular system as simple aortitis, aortic valve insufficiency, coronary artery stenosis or obstruction, Aortic aneurysm and mucinous myocarditis. In most case reports on the subject, acute myocardial infarction caused by syphilis was reported to be due to aortic valve insufficiency and coronary stenosis as a result of the involvement of the aorta.
Patient Concerns:
The patient was a 48-year-old woman. She was admitted to our hospital because of intermittent upper abdominal pain with chest tightness for 3 hours. The patient reported a past syphilis infection, when she was hospitalized for hysteromyoma surgery four years ago, and had no related treatment.
Diagnosis:
According to the characteristics of coronary angiography and results of lab tests and echocardiography, she was finally diagnosed with myocardial infarction associated with syphilis.
Interventions:
At the first diagnosis of syphilis, the patient did not received antibiotics treatment. After the diagnosis of myocardial infarction, she received the percutaneous coronary intervention (PCI) operation assisted by extracorporeal membrane oxygenation (ECMO) technology, successfully got drug -eluted stents in right coronary artery ostium and left main ostium. Then the patient received penicillin to treat the syphilis infection.
Outcomes:
After coronary revascularization, the cardiac function of the patients was gradually improved, and the left ventricular ejection fraction was gradually improved after combined with optimized drug therapy.
Lessons:
The cardiovascular system is often involved in the stages of advanced syphilis with severe complications like myocardial infarction. Standard treatment should be given as soon as syphilis is diagnosis. For stenosis of coronary ostium, the PCI assisted by ECMO technology did not only ensure the effectiveness of the treatment, but also reduce the surgical risk of the patient. This case indicated the effectiveness of ECMO-assisted PCI, and thus may provide a reference for future patient treatment.
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