3: Cardio - Kawasaki Disease

Question 1

What is Kawasaki disease referred to as

Answer 1

Mucocutaneous Lymph Node Syndrome

Question 2

What is Kawasaki disease

Answer 2

Febrile vasculitis - predominantly affecting coronary and medium size vessels

Question 3

Which age-group does Kawasaki disease occur

Answer 3

Under 5’s

Question 4

What gender is Kawasaki disease more common in

Answer 4

Males

Question 5

What ethnicity does Kawasaki disease occur in

Answer 5

Asians

Afro-carribeans

Question 6

What is the most common cause of acquired heart disease in developed countries

Answer 6

Kawasaki Disease

Question 7

What is the most common cause of acquired heart disease in developing countries

Answer 7

Rheumatic Fever

Question 8

What is a mnemonic to remember symptoms of Kawasaki disease

Answer 8

CRASH and burn

Conjunctivitis 
Rash
lymphAdenopathy
Strawberry tongue
Hand + feet - red 

Burn: Fever >5d

Question 9

What is the criteria for Kawasaki disease

Answer 9

Need 5-out-of-6 of the following:

1. Fever >5d
2. Oropharyngeal mucositis
3. Lymphadenopathy
4. Polymorphous Rash
5. Bilateral, Non-purulent conjunctivitis
6. Red hand + feet - lead to desquamatisation

Question 10

How long should the fever last in Kawasaki disease

Answer 10

5d

Question 11

What are three symptoms/signs of oropharyngeal mucositis

Answer 11

• Red pharynx
• Strawberry tongue
• cracked red lips

Question 12

What type of conjunctivitis is present in Kawasaki disease

Answer 12

Bilateral, non-purulent conjunctivitis

Question 13

What type of rash is present in Kawasaki disease

Answer 13

Polymorphous rash - which originates on the trunk

Question 14

Where does the rash in Kawasaki disease originate

Answer 14

The trunk

Question 15

What is the mneumonic to remember symptoms of Kawasaki disease

Answer 15

CRASH and BURN

Question 16

What are three non-specific features of Kawasaki disease that may precede classical symptoms

Answer 16

Abdominal pain
Diarrhoea
Faitgue

Question 17

When should Kawasaki disease always be considered

Answer 17

If child has rash and high temperature that is not responding to Abx

Question 18

Explain pathophysiology of Kawasaki disease

Answer 18

• Autoimmune damage to vessels exposes TF on the endothelium of medium-size and coronary arteries
• This triggers the coagulation cascade leading to thrombosis
• Of coronary vessels this can cause MI
• Damage to artery walls causes weakening that can lead to aneurysms - may rupture
• Damage and healing by fibrosis also results in stenosis

Question 19

How is Kawasaki disease diagnosed

Answer 19

Clinical diagnosis, supported by investigations

Question 20

What investigations may be ordered in Kawasaki disease

Answer 20

1. ESR/CRP
2. FBC
3. Anti-endothelial cell antibodies
4. ECHO

Question 21

How will ESR and CRP present in Kawasaki disease

Answer 21

Raised

Question 22

How will FBC present in Kawasaki disease

Answer 22

Leucocytosis

Thrombocytosis

Question 23

Why is an ECHO required in Kawasaki disease

Answer 23

Evaluate for coronary aneurysms

Question 24

What is given to manage Kawasaki disease

Answer 24

1. IVIG
2. High-dose Oral aspirin
3. IV Glucocorticoids

Question 25

When should IVIG be given in Kawasaki disease

Answer 25

Within 10d

Question 26

What is the advantage of giving IVIG within 10d in Kawasaki disease

Answer 26

Reduces risk of coronary artery aneurysms

Question 27

What is the only exception to give aspirin to children under 16

Answer 27

Kawasaki disease

Question 28

Why is aspirin not normally given to children under 16y

Answer 28

Risk of Reye's syndrome

Question 29

When is IV Glucocorticoids given in Kawasaki disease

Answer 29

High risk patients or refractory disease

Question 30

How long does Kawasaki disease take to resolve

Answer 30

6-8W

Question 31

What is the main risk of Kawasaki disease

Answer 31

Coronary artery aneurysms - more common 2-3W in

Question 32

What are 3 other cardiac risks of Kawasaki disease

Answer 32

MI Arrythmias Myocarditis