The rôle of syphilis in the etiology of angina pectoris, coronary arteriosclerosis and thrombosis, and of sudden cardiac death

T ;IE r6le played by syphilis in the etiology of angina pectoris, coronary sclerosis and thrombosis, and of cardiac infarction has never been clearly evaluated ; and varying opinions have been held by clinicians as to its importance in the production of these conditions. The most recent writers, as Levine, believe that syphilis is rarely an underlying factor in the causation of coronary thrombosis. In only three of Levine’s eighty-nine cases in which a Wassermann reaction was done was there a positive reaction, and in one other case with a negative reaction, there was a history of a primary infection. From this it would appear that only 4.5 per cent of his patients were syphilitic, and it does not necessarily follow that in these cases the syphilis was the etiologic factor in the production of coronary thrombosis. In one case only, a patient only thirty-six years old, the youngest in his series, did this seem likely. In the other cases the syphilis may well have been coincidental. Levine decides that coronary thrombosis and myocardial infarction are rarely caused by syphilis. However, in Levine’s cases the diagnoses were chiefly clinical and gross pathological. In only forty-six of the cases were autopsies done, and t,he microscopic diagnosis of syphilis does not seem to have been considered. It is possible that microscopic criteria for the diagnosis of syphilis might have increased the percentage of syphilitics in his material. In thirteen autopsies on patients dying of coronary disease reported by W. J. Stone, microscopical examination showed syphilitic periarteritis in two cases. In eighty-six autopsies of coronary sclerosis, Willius and Brown found syphilis of the aorta in 19 per cent.