Hindawi Publishing CorporationCase Reports in MedicineVolume
2010, Article ID 830583, 4 pagesdoi:10.1155/2010/830583
Case Report
Syphilitic Coronary Artery Ostial StenosisResulting in Acute
Myocardial Infarction Treated byPercutaneous Coronary
Intervention
Marcelo A. Nakazone,1, 2 Maurcio N. Machado,1 Raphael B.
Barbosa,1
Marcio A. Santos,1 and Lilia N. Maia1
1Department of Cardiology and Cardiovascular Surgery, Sao Jose
do Rio Preto Medical School,15090-000 Sao Jose do Rio Preto, SP,
Brazil
2Department of Molecular Biology, Sao Jose do Rio Preto Medical
School, Avenue Brigadeiro Faria Lima 5416, 15090-000Sao Jose do Rio
Preto, SP, Brazil
Correspondence should be addressed to Marcelo A. Nakazone, naka
[email protected]
Received 17 August 2010; Revised 27 September 2010; Accepted 6
October 2010
Academic Editor: Peter M. Van Ooijen
Copyright 2010 Marcelo A. Nakazone et al. This is an open access
article distributed under the Creative Commons AttributionLicense,
which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properlycited.
Cardiovascular abnormalities are well-known manifestations of
tertiary syphilis infections which although not frequent, are
stillcauses of morbidity and mortality. A less common manifestation
of syphilitic aortitis is coronary artery ostial narrowing
relatedto aortic wall thickening. We report a case of a 46-year-old
male admitted due to acute anterior ST elevation myocardial
infarctionsubmitted to primary percutaneous coronary intervention
successfully. Coronary angiography showed a suboccluded ostial
lesionof left main coronary artery. VDRL was titrated to 1/512. The
patient was discharged with treatment including
benzathinepenicillin. Previous case reports of acute myocardial
infarction in association with syphilitic coronary artery ostial
stenosis havebeen reported, but the fact that the patient was
treated by percutaneous coronary intervention is unique in this
case.
1. Introduction
Syphilitic obliteration of the coronary ostia is an
uncommonmanifestation of tertiary syphilis infection [1].
Cardiovas-cular syphilis should be considered in cases of
coronaryartery ostial lesion with a normal distal bed [2]. This
paperdescribes a case of a 46-year-old male without risk factorsfor
atherosclerosis admitted with acute anterior ST elevationmyocardial
infarction treated by percutaneous coronaryintervention in a
patient with syphilitic coronary artery ostialstenosis.
2. Case Report
In June 2010, a 46-year-old male presented to the emer-gency
department with sudden onset of severe chest pain,associated to
progressive dyspnea and diaphoresis. He was
a smoker but had no other risk factors for coronaryartery
disease. He had never received radiotherapy orchemotherapy. The
patient was tachypneic at 26 breaths/minat admission, with regular
rhythm at 160 beats/min. Hisblood pressure was 130/80mmHg, and
oxygen saturationmeasured through pulse oximetry was 83%. Cardiac
auscul-tation was normal, and crackles were heard over lungs.
Thepatient was submitted to orotracheal intubation and inva-sive
mechanical ventilation considering acute pulmonaryedema.
Electrocardiography showed sinus rhythmwith ST eleva-tion in
leads I, aVL, aVR, V1 to V5 and ST depression in leadsDII, DIII,
and aVF, compatible with anterolateral wall acutemyocardial
infarction (Figure 1). Acetylsalicylic acid andclopidogrel were
administered, and the patient was routedto the catheterization
laboratory. Coronary angiographyshowed a suboccluded ostial lesion
of left main coronary
4 Case Reports in Medicine
Acknowledgments
The authors would like to thank Professor Dr. Irineu LuizMaia
and Professor Dr. Celso Francisco Hernandes Granatofor their
assistance with the paper about manifestations oftertiary syphilis
infections.
References
[1] V. Schrive, C. N. Barnard, and W. Beck, Syphilitic
coronaryostial occlusion, South African Medical Journal, vol. 40,
no.24, pp. 553555, 1966.
[2] M. D. N. Machado, P. F. Trindade, R. C. Miranda, and L.N.
Maia, Bilateral ostial coronary lesion in cardiovascularsyphilis:
case report, Brazilian Journal of CardiovascularSurgery, vol. 23,
no. 1, pp. 129131, 2008.
[3] S. Holt, Syphilitic ostial occlusion, British Heart Journal,
vol.39, no. 4, pp. 469470, 1977.
[4] H. A. Heggtveit, Syphilitic aortitis. A
clinicopathologicautopsy study of 100 cases, 1950 to 1960,
Circulation, vol. 29,pp. 346355, 1964.
[5] A. H. Ferrari, T. Miyagui, I. K. Praxedes, and W. T.
Soares,Luetic ostial mesoaortitis and myocardial infarction. A
casereport, Arquivos Brasileiros de Cardiologia, vol. 46, no. 6,
pp.421424, 1986.
[6] S. Gomes, Incidencia de reacoes sorologicas positivas
parasfilis na populacao carceraria de Niteroi, Arquivos
Brasileirosde Medicina, vol. 59, no. 4, pp. 275278, 1985.
[7] D. H. Rockwell, A. R. Yobs, andM. B.Moore Jr., The
Tuskegeestudy of untreated syphilis: the 30th year of
observation,Archives of Internal Medicine, vol. 114, pp. 792798,
1964.
[8] S. Y. C. Tong, H. Haqqani, and A. C. Street, A pox on
theheart: five cases of cardiovascular syphilis, Medical Journal
ofAustralia, vol. 184, no. 5, pp. 241243, 2006.
[9] K. Tanaka, M. Takeda, and K. Nagayama, Composite Y-graftfor
syphilitic ostial stenosis in left main coronary artery,
AsianCardiovascular and Thoracic Annals, vol. 15, no. 2, pp.
159161, 2007.
[10] J. D. Jackman Jr. and J. D. Radolf, Cardiovascular
syphilis,American Journal ofMedicine, vol. 87, no. 4, pp. 425433,
1989.
[11] S. Darabian, A. R. Amirzadegan, H. Sadeghian, S.
Sadeghian,A. Abbasi, and M. Raeesi, Ostial lesions of left main and
rightcoronary arteries: demographic and angiographic
features,Angiology, vol. 59, no. 6, pp. 682687, 2009.
[12] R. C. Carneiro, M. F. Lion, P. R. G. Oliveira, and E. San
Juan,Syphilitic coronary ostial obstruction, Arquivos Brasileiros
deCardiologia, vol. 29, no. 3, pp. 235239, 1976.
[13] J. L. W. Kennedy, J. J. Barnard, and J. A. Prahlow,
Syphiliticcoronary artery ostial stenosis resulting in acute
myocardialinfarction and death, Cardiology, vol. 105, no. 1, pp.
2529,2005.
[14] R. Sultana, N. Sultana, S. Z. Rasheed, M. Ishaq, and
A.Samad, Percutaneous coronary intervention for chronic
totalcoronary occlusion in patients at Karachi Institute of
HeartDiseases, Journal of the Pakistan Medical Association, vol.
66,no. 6, pp. 420422, 2010.
[15] A. Om, S. Ellahham, and G. W. Vetrovec,
Radiation-inducedcoronary artery disease, American Heart Journal,
vol. 124, no.6, pp. 15981602, 1992.
[16] H. Aronow, M. Kim, and M. Rubenfire, Silent
ischemiccardiomyopathy and left coronary ostial stenosis secondary
toradiation therapy, Clinical Cardiology, vol. 19, no. 3, pp.
260262, 1996.
[17] A. Vallebona, Cardiac damage following therapeutic
chestirradiation: importance, evaluation and treatment,
MinervaCardioangiologica, vol. 48, no. 3, pp. 7987, 2000.
[18] J.-F. Fuzellier, P. Mauran, and D. Metz,
Radiation-inducedbilateral coronary ostial stenosis in a
17-year-old patient,Journal of Cardiac Surgery, vol. 21, no. 6, pp.
600602, 2006.
[19] C. Lanjewar, P. Kerkar, P. Vaideeswar, and S. Pandit,
Isolatedbilateral coronary ostial stenosisan uncommon presenta-tion
of aortoarteritis, International Journal of Cardiology, vol.114,
no. 3, pp. E126E128, 2007.
[20] U. Bortolotti, A. Milano, A. Balbarini et al.,
Surgicalangioplasty for isolated coronary ostial stenosis, Texas
HeartInstitute Journal, vol. 24, no. 4, pp. 366371, 1997.
[21] H. Kawakami, H. Matsuoka, Y. Koyama et al., Isolated
leftcoronary ostial stenosis as a result of fibromuscular
dysplasiain a young man, Japanese Circulation Journal, vol. 64, no.
12,pp. 988989, 2000.
IntroductionCase ReportDiscussionAcknowledgmentsReferences