Syphilitic Heart Disease

¹ Clinical Assistant Professor of Medicine, University of Minnesota, St. Paul, Minnesota.

Of the 161 patients with syphilitic heart disease the following clinical facts were obtained:

1) In the diagnosis of syphilitic heart disease, one should obtain a positive Wassermann test. or the history of syphilitic infection.

2) If we assume that the presence of a positive spinal fluid indicates an infection in the central nervous system, then, contrary to popular belief, central nervous system syphilis is rather common in syphilitic heart disease.

3) When the problem arises as to the etiology of the aortic valve defect, the following facts are important:

(a) Whenever the physical findings are those of a stenosing lesion, then the lesion is rheumatic.

(b) In the presence of a regurgitating type of lesion, the evidence seems to indicate that the lesion is probably luetic.

(c) If we have a diastolic murmur at the apex in the presence of a frank aortic insufficiency and the heart is enlarged to the left, the diagnosis of mitral stenosis even in the presence of a history of rheumatic fever is hazardous. On the other hand, a diastolic murmur at the apex, in the presence of a frank syphilitic aortic insufficiency with the history of rheumatic fever and with the left ventricle not being enlarged, usually means an associated rheumatic mitral valve defect. The diagnosis is further supported if there is an associated auricular fibrillation.

4) Subacute bacterial endocarditis is rare in syphilitic heart disease, yet in five patients this phenomenon did occur. In four, the lesion was superimposed upon an associated rheumatic valve defect and in only one case upon a pure luetic valve defect.

5) The popular opinion that auricular fibrillation is unusual in syphilitic heart disease is widely held and yet, there were eight instances of patients suffering from syphilitic heart disease with auricular fibrillation. In every instance, however, the auricular fibrillation was associated with some complicating factor such as hypertension or rheumatic heart disease.

The results of the analysis of 161 cases of syphilitic heart disease have been tabulated. While the number is too small to be statistically significant, the analysis presents the pattern of the disease as it was seen at the Ancker Hospital.