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Comparing rheumatic and syphilitic aortic regurgitation

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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