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Comparing rheumatic and syphilitic aortic regurgitation

Authoring team

The aortic regurgitation seen in cardiovascular syphilis and rheumatic heart disease are compared and contrasted below:

  • angina:
    • an earlier and more frequent feature of syphilitic aortic regurgitation (SAR) than rheumatic aortic regurgitation (RAR) because syphilitic aortitis may cause coronary ostial stenosis

  • diastolic murmur:
    • in SAR the dilated aorta associated with syphilitic aortitis may cause the murmur to be maximal to the right of the sternum
    • in RAR the murmur is maximal at the left sternal edge
    • the murmur in SAR is usually louder

  • heart block - seen more commonly in SAR

  • aortic stenosis:
    • does not occur in syphilitic aortic valve disease

  • atrial fibrillation:
    • may complicate RAR and SAR
    • atrial fibrillation complications RAR then mitral valve disease should be suspected

  • serology:
    • in SAR specific tests are usually positive, e.g. FTA-ABS
    • syphilis screening tests, e.g. VRDL are negative in up to 70% of cases of syphilitic aortitis

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