7.6 Acquired Cardiac Conditions Flashcards
Rheumatic Fever
- Inflammatory disease caused by Group A Strep Infection
- Self Limiting but affects multiple areas of the body (joints, skin, brain, CNS, heart)
- Can cause cardiac valve damage (MOST SERIOUS COMPLICATION)
Treatment
- Treatment of Strep prevents RF
- Education on completing full course of antibiotic therapy
Diagnosis
- Titer for Strep
- ESR to look for inflammation
- ECHO to look at manifestations in the heart
Manifestations of Rhematic Fever
- Rheumatic Carditis (inflammation of heart)
Symptoms of Carditis
- New Murmurs
- Extreme Tachycardia
- Cardiomegaly and HF
- Progressive Valve Damage
Pericarditis can cause muffled heart sounds or friction rub
Manifestations of Rheumatic Fever
Polyarthritis (Caused by edema and inflammation around joints)
- This arthritis can migrate to larger joints (knees, elbows, hips, shoulders, wrists)
- This causes joints to be swollen, hot, red, painful for 1-2 days then moves to another joint
- Usually occurs in the first couple weeks when patient is febrile (fever) but may last months if untreated
Manifestations of Rheumatic Fever
- Erythema Marginatum (macular rash wish a clear center and wavy, well-demarcated border)
- Usually found on trunk and proximal extremities
- Non-pruritic and resolves on its own (not itchy)
Manifestations of Rheumatic Fever
- Subcutaneous nodules over bony prominences
- Small and non-tender (0.5-1
Manifestations of Rheumatic Fever
- Subcutaneous nodules over bony prominences (feet, hands, elbows, scalp, scapulae, vertebrae)
- Small and non-tender (0.5-1 cm)
- Can persist for a long time but resolve with time
- Not painful
Manifestations Rheumatic Fever (Severe)
- Chorea (CNS symptoms of inflammation)
- Sudden aimless irregular movement, speech disturbances, emotional lability, muscle weakness
- Sometimes does not appear until 6 months after exposure
- Symptoms can also last for a long time 6+ months
Diagnosis/Treatment Rheumatic Fever
Diagnosis
- Titer to check for strep infection
- Titer checks for streptolysin o which is seen at 1 week and peaks at 4-6 weeks
- 2 positive titers show proof of exposure
Treatment
- Eradicate strep with antibiotics
- May need prophylactic antibiotic therapy in the future to prevent re-occurrence
- Salicylates and prednisone to decrease inflammation
Education
- Must complete full course of antibiotics
Kawasaki Disease
- Acute systemic vasculitis (inflammation of small vessels) of unknown cause
- NOT SPREAD THROUGH DIRECT CONTACT
- Self limiting and resolves in 6-8 weeks
- 1/4 of patients end up with cardiac issues
(Dilated Coronary Arteries)
(Coronary Artery Aneurism) - CHILDREN YOUNGER THAN 1 HAVE THE GREATEST RISK OF CARDIAC INVOLVEMENT
Pathophysiology of Kawasaki Disease
- Progressive inflammation of small vessels
- This can cause pan carditis (inflammation of various portions of the heart)
- Enlargement of Coronary Arteries seen on echo in 7 days
- C-Reactive Protein (CRP) and ESR are elevated (both inflammation markers)
- Resolves in 6-8 weeks
Kawasaki Disease Acute Phase
Signs and Symptoms
- Abrupt High Fever unresponsive to antibiotics or antipyretics
- Bulbar Conjunctivae of the Eye (red sclera and clearing around iris)
- Inflamed oral mucosa, red cracked lips, strawberry tongue
- Rash in perineum
- Hands and feet are bright red
- Desquamation (skin peeling) of perineum
Sub-Acute Phase
- Fever starts to resolve
- Periungual peeling of fingers and toes in second and third week
- Temporary arthritis
- Irritability
Convalescent Phase
- Clinical signs and symptoms are mostly resolved but lab values still show increased inflammation (CRP and ESR)
- Thrombocytosis (too many platelets) may be present
- Arthritis may continue
- This stage ends when parents report that their child has returned back to normal in temperament, energy, and appetite
Treatment for Kawasaki Disease
- HIGH DOSES OF IVIG given in the 1st 10 days of illness but preferably within the 1st 7 days.
- HIGH DOSE ASPIRIN 80-100 mg/kg/day q6h (one of the few times we give aspirin to kids)
- Once child is a-febrile for 48-72 hours we can drop aspirin to 3-5 mg/kg/day. Low dose aspirin continued until platelet counts normalize
- If child has coronary consequences low dose aspirin is continued indefinitely
- Anticoagulants may be used (warfarin or lovenox)
Kawasaki Characteristics
- Red hands and feet
- Red eyes
- Strawberry tongue
- Peeling of extremities
- Fever that does not go away
Another Format
- Irritability
- Erythema in palms and soles
- Bilateral conjunctiva inflammation
- Temperature over 100.4 for the last 5 days
- Inflammation of pharynx with red, cracked lips, and strawberry tongue
