Q... Cardio... Hit the ground :) - drock

[ArchivalUser]

Pt has S-T depression which means ischemia, BUT S-T depression is cause as well due to electrolytes abnormalities, Lt ventricular hypertrophy. This pt has as well left axis deviation which mean Lt ventricular hypertrophy most likely due to syphilitic aortitis
DDDDDD

[ArchivalUser]

in tertiary syphilis thoracic aorta dilates and can rupture............... will go with DD syphilitic aortitis

[ArchivalUser]

cardiac catherisation

[ArchivalUser]

Answer is (D) VDRL and lumbar puncture, followed by penicillin therapy


This patient has a murmur of aortic regurgitation (AR) and an abnormal neurological examination, suggesting syphilis. Therefore, this patient needs a VDRL and a lumbar puncture.

Syphilis of the aorta involves the intima of the coronary arteries and may narrow the coronary ostia, leading to myocardial ischemia. There is also destruction of the medial muscle layers of the aorta, leading to aortic dilation. Myocardial ischemia in AR happens because oxygen requirements are elevated secondary to left ventricular (LV) dilatation and elevated LV systolic wall tension. Coronary blood flow is normally during diastole when the diastolic arterial pressure is subnormal. This leads to decreased coronary perfusion pressure.

Nifedipine or ACE inhibitors are only used once the patient develops severe AR. Digoxin is of very limited use at any time. An exercise stress test is not indicated because of the baseline EKG abnormalities. You normally detect the presence of ischemia on a stress test by looking for the development of ST-segment depression. This patient already has baseline ST-segment depression. A thallium or sestamibi scan would be required in a case like this. If you were investigating for ischemia, surgical treatment does not restore normal LV function.

Patients with AR and normal LV function are followed until surgery is indicated. This is when the patient has LV dysfunction but before the development of symptomatic congestive failure. Valve replacement is also indicated in asymptomatic patients when the ejection fraction falls to 55 mL/m2. Although catheterization may be useful before surgery, it would not be done before a specific diagnosis of syphilitic aortitis has been confirmed and treatment with penicillin has been given.

[ArchivalUser]

very good & analytical q d rock.... frens... why do we do lumbar puncture in this case? the case is suggestive of cardiovasc/neurosyphilis though ...to rule out meningitis?