Acute coronary syndrome of very unusual etiology. Issue 5 (21st January 2018)

• Record Type: Journal Article
• Authors: Barbosa‐Barros, Raimundo; Pérez‐Riera, Andrés R.; Koivula, Kimmo; de Carvalho Santos, Jairo; de Abreu, Luiz C.; Nikus, Kjell
• Is Part Of: Annals of noninvasive electrocardiology. Volume 23:Issue 5(2018:Sep.)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-01-21
• Subjects: acute coronary syndrome -- coronary artery disease -- syphilitic aortitis; Electrocardiography -- Periodicals; Arrhythmia -- Periodicals; 616.1207547
• DOI: 10.1111/anec.12531
• Languages: English
• ISSNs: 1082-720X

Abstract

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.