Cardiovascular syphilis is the most common cause of death from acquired syphilis; however, it very difficult to detect early. Objective. To evaluate the clinical features of cardiovascular syphilis in the Republic of Belarus, the possibility of its early laboratory and instrumental diagnosis and treatment optimization. Material and methods. A retrospective analysis of primary medical records of patients with cardiovascular syphilis has been performed to identify the most relevant aspects in the medical history, as well as laboratory, instrumental and pathomorphological data and features of the therapy. We analyzed the reports of the dermatovenereological service of the Republic of Belarus for the years 2004-2013 and examined three cases of cardiovascular syphilis in details. Results. The prevalence, clinical presentation, diagnosis and treatment of cardiovascular syphilis have been discussed. Three cases of cardiovascular syphilis have been analyzed. Conclusions. Treponemal test should be used to screen for syphilis in case of myocarditis, aortitis, aortic aneurysm, acquired heart diseases, and inflammatory changes in parenchymal organs of unknown etiology. Routine diagnostic methods (physical examination, X-ray) do not allow early diagnosis of cardiovascular syphilis. Therefore, ultrasound imaging of heart and aorta must be performed if the following diseases are suspected: syphilis involving the cardiovascular system (A52.0), other symptoms of late visceral syphilis (A52.7), late latent syphilis (A52.8), and serum-resistant syphilis (A53.1). The risk of severe bleeding is substantially increased in case of concomitant administration of penicillins and an anticoagulant agent, such as warfarin (e.g. after heart valve replacement).