Syphilitic heart disease is a condition resulting from syphilis, which involves the heart and great vessels, especially the aorta.

The causative agent for syphilis is the Treponema pallidum, which involves the heart and blood vessels during the tertiary stage of the disease. It occurs in late syphilis.

The signs and symptoms may include saccular aortic aneurysms, aortitis, aortic valve insufficiency/regurgitation (see Diagnostic Code: 7000 Valvular heart disease), and/or congestive heart failure (CHF). There also may be signs of decreased cardiac output such as decreased urine output, hypoxia, or altered sensorium. The person may experience no symptoms at all.

The functional abilities of cardiac patients can be classified in terms of metabolic equivalents (METs). The classification is generally as follows:

• Light to medium housework is 2 to 4 METs

• Heavy housework or yard work is approximately 5 to 6 METs

• Strenuous activity would be 7 to 10 METs, etc.

To determine the limitations on patient's functional abilities the METs are considered in accordance with what symptoms are exhibited when the activities are carried out. For example, if a patient is performing activity at the 2 to 4 MET level and experiences dyspnea, fatigue, dizziness or fainting, the patient is considered to have low functional abilities.

Blood cultures, electrocardiogram (EKG), and other tests related to aortic valve insufficiency which include echocardiogram, and Doppler echocardiogram may be ordered.

Treatment plans vary depending upon specific symptoms and damage incurred as a result of the infection. A biopsy or surgical intervention may be performed.

Residual may vary ranging from no residuals to any combination of signs and symptoms. The patient should have blood tests at 6-month intervals for a period of up to 2 years.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

Notes

• Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it.

• One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, a medical examiner may estimate the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms.

• For this general formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.

• Evaluate syphilitic aortic aneurysms under DC 7110 (Aortic aneurysm: Ascending, thoracic, abdominal).

• The rating criteria for cardiovascular conditions underwent full-scale revision effective on November 14, 2021 and January 12, 1999.  A regulatory change was effective August 13, 1998, updated criteria for cold injury residuals under 38 CFR 4.104, DC 7122. The changes are not considered liberalizing and should not be used as the basis for reduction unless the disability has actually improved.