Acquired heart conditions

Question 1

What is Kawasaki’s disease?

Answer 1

A systemic vasculitis

Question 2

What age do children get Kawasaki’s disease?

Answer 2

6 months to 4 years with peak at the end of 1 year

more common in children of japanese descent

Question 3

How is Kawasaki’s disease diagnosed?

Answer 3

No diagnostic test, clinical finding only

- 4/5 major finding on background of fever for >5 days

Question 4

Clinical features of Kwasaki’s disease

Answer 4

‘FEEL My Conjunctivitis’

1. Fever - for more than 5 days
2. E - oedema, refuses to walk
3. E - rythematous rash
4. L- ymphadenopathy - cervical lymph nodes
5. M - ucous membranes affected
6. Conjunctivitis - bilateral and non purulent and limbic sparing around the iris

Question 5

Features of rash in Kawasaki’s disease

Answer 5

1. Polymorphic
2. Diffuse over a large portion
3. Peeling of fingers and toes

Question 6

Features of mucous changes in Kawasaki’s disease

Answer 6

1. Strawberry tongue

2. Dry and cracked lips

Question 7

Ix of kawasaki’s disease

Answer 7

1. High inflammatory markers - C reactive protein, ESR
2. Platelet count rises in the second week
3. Echo - shows narrowing of blood vessels

Question 8

Complications of kawasaki’s disease

Answer 8

1. Coronary arteries affected in 1/3 cases
   - Coronary artery aneurysms and sudden death
2. Coronary thrombosis - high platelet count can cause thrombosis to form

Question 9

Tx of Kawasaki’s disease

Answer 9

1. IV immunogobulin within the first 10 days - reduces the risk of coronary artery aneurysms
2. High dose of Asprin - control platelet count and inflammatory markers

Question 10

Hypertrophic cardiomyopathy

Answer 10

1. 50% autosomal dominant condition
2. Hypertrophied LV
3. Angina / weakness/ failure

Question 11

Dilated cardiomyopathy

Answer 11

1. Most common cardiomyopathy
2. Mainly idiopathic
3. Fatigue/ weakness

Question 12

Risk factors of bacterial endocarditis

Answer 12

1. turbulent jet of blood as with;
VSD
Coarctation of aorta
Persistent ductus arteriosis
2. Prosthetic material

Question 13

Peripheral stigmata of bacterial endocarditis

Answer 13

1. Splinter haemorrhages
2. Clubbing
3. Osler’s nodes
4. Janeway lesions

Question 14

2 causes of bacterial endocarditis in neonates

Answer 14

1. Staph aureus

2. Candida

Question 15

2 causes of bacterial endocarditis in children

Answer 15

1. Strep viridans
2. Enterococci
3. Staph aureus

Question 16

Clinical features of bacterial endocarditis

Answer 16

1. Prolonged low grade fever
2. Anaemia and pallor
3. Splenomegaly
4. Arthritis and athralgia

Question 17

Most common cause of bacterial endocarditis

Answer 17

1. Streptococcus Viridans

Question 18

Myocarditis

Answer 18

Inflammation of the myocardium

mostly viral in origin - cmv/polio/HIV

Question 19

Clinical features of myocarditis

Answer 19

Neonate - sudden onset 
- HF signs
- anorexia / vomiting / lethargy
- mortality of 75 %
Older children may have history of URTI