Comparing rheumatic and syphilitic aortic regurgitation

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