Changes in the electrocardiogram following the arsphenamine treatment of cardiac and aortic syphilis.

Abstract

We have recently observed conspicuous changes in the electrocardiogram following the administration of arsphenamine in four cases of cardiac and aortic syphilis.

A patient with syphilitic myocarditis and complete right bundle branch block developed an abnormal idioventricular rhythm following the administration of two-tenths gram of arsphenamine and died a few days later. For several weeks preceding the treatment his condition had been stationary.

Two patients with syphilitic aortitis, but without definite signs of cardiac syphilis, and with practically normal electrocardiograms, developed diphasic complexes suggesting incomplete bundle branch block, following intensive arsphenamine therapy. In one of these patients the T-wave changes gradually disappeared but the QRS changes persisted. The other patient could not be followed. Similar but less conspicuous changes occurred in a third patient with syphilitic aortitis who showed great enlargement of the heart and left ventricular preponderance before treatment.

These observations indicate that the administration of aspenamine in cases of cardiac syphilis may sometimes be followed by myocardial changes of an undesirable kind. The slow development and persistence of the electrocardiographic changes suggest that they are not due to a local Herxheimer reaction, although this possibility cannot be excluded. The rapid destruction of the luetic lesions and their replacement by scar tissue with injury to the intraventricular conducting system, directly or through interference with the coronary circulation, is a possible cause.