Acquired Heart Disease (Rheumatic, Kawasaki, Endocarditis) Flashcards
Cath findings for constrictive pericarditis
RAP = PCWP
RVEDP = LVEDP within 4 mmHg
RVSp usually < 50 mmHg
Cath findings for restrictive cardiomyopathy
PCWP and LVEDP may exceed RAP and RVEDp by > 4 mmHg
RVSp often > 50 mmHg
EKG findings in constrictive pericarditis vs. restrictive cardiomyopathy
Constrictive pericarditis have low voltage QRS, don’t usually have LVH/RVH and may or may not have atrial enlargement
Restrictive cardiomyopathy usually have LVH/RVH and nearly always have atrial enlargement
What are Libman Sacks lesions
- Seen in endocarditis
- Verrucous non bacterial lesion in lupus on the mitral valve
- On echo they are irregular lesions less than 0.5 cm in diameter on the valve or chordal apparatus
Major criteria for Rheumatic fever
JONES
- Joints (polyarthritis)
- Carditis
- Nodules (subcutaneous)
- Erythema marginatum
- Sydenham’s chorea
- Sydenham’s chorea
Diagnosis needs 2 major criteria plus preceding strep infection or 1 major and 2 minor
3 cardiac findings in anorexia patient
- Mitral valve prolapse - midsystolic click with late systolic murmur
- Bradycardia
- EKG findings: AV block, prolonged QT, ST depression, T wave inversion
Antiplatelet/anticoagulation management for Kawasaki patients based on coronary Z scores
- Z < 2 - antiplatelet for 4-6 weeks with counseling
- Z 2.5-5 - low dose aspirin for first 6 weeks
- Z 5-10 - long term antiplatelet
- Z > 10 or absolute > 8 mm - long term antiplatelet plus anticoagulant and possible beta blocker pending blood pressure
What’re the most common valves affected with endocarditis
MV and AV
Most common pathogens for endocarditis in CHD, non-CHD, neonates and adultts
CHD: Strep
Non-CHD: Staph
Adults: Enterococcus
Neonates: Candida
Percentage of cases with culture negative endocarditis
5%
Conditions that require endocarditis prophylaxis
- Prosthetic valves
- Previous endocarditis
- 6 months post cath/surgery
- Unrepaired cyanotic CHD
- Repaired CHD with residual lesion next to the repair
- Transplant patient with valvulopathy
Duke criteria diagnosis for endocarditis
- Major: positive culture (typical organism in 2 cultures > 12 hours apart or single culture for Coxiella), positive echo
- Minor: predisposing risk, fever, vascular phenomenon (Janeway lesions, thrombi), immune phenomenon (glomerulonephritis, Osler’s nodes, Roth spots), micro evidence that doesn’t meet major criteria
Kawasaki epidemiology age, gender, time of year
- Mostly in children < 5 yo
- Most in winter/spring
- More in males than females
- 10x risk in siblings
- 3% risk of recurrence
Most to least common coronaries involved in Kawasaki
- Proximal LAD
- Proximal RCA
- LMCA
- Circumflex
- Distal RCA
- Junction between distal RCA and PDA
Kawasaki disease diagnostic criteria
Fever for 5 days plus 4/5:
- Erythema of tongue/lips, bilateral conjunctival erythema (limbic sparing), diffuse erythematous rash, erythema/edema of hands/feet, unilateral cervical lymphadenopathy (> 15 mm)
Lab findings in Kawasaki disease
Need 3 for incomplete: sterile pyruia, elevated inflammatory markers, anemia, thrombocytopenia, low albumin, elevated ALT, elevated WBC
Coronary artery Z scores for Kawasaki
- Nl < 2
- 2.5-5: small
- 5-10 and < 8 mm: medium
- > 10 or > 8 mm: giant
Percentage of acute rheumatic fever that becomes chronic rheumatic heart disease in high risk populations
60%
Most commonly affected valves in rheumatic heart disease
AV and MV
- Right heart lesions uncommon
Echo findings in acute rheumatic heart disease
- Mitral valve: annular dilation, chordal rupture, anterior leaflet prolapse, thick tips
- Aortic valve: coaptation defects, restricted leaflet motion, leaflet prolapse
Echo findings in chronic rheumatic heart disease
- Mitral valve: thick leaflets, restricted motion, calcification, thickened chords
Jones criteria for rheumatic heart disease
- Joints (polyarthritis)
- Carditis
- Nodules (subcutaneous)
- Erythema marginatum
- Sydenham’s chorea
Minor Jones criteria for rheumatic heart disease
- Fever
- Polyarthralgias
- Prolonged PR
- Elevated inflammatory markers
Length of antibiotic for prophylaxis of rheumatic heart disease
- No carditis - for 5 years or until 21
- Mild/resolved carditis - 10 years or until 21
- If residual valve disease or mod/severe disease then until 30s-40s or sometimes for life
Characteristics of fibromas
- Single, firm, intramural tumors involving ventricular free wall or septum
- Ventricular arrhythmias are common
Most common causes of viral myocarditis
Enterovirus (Coxsackie)
Adenovirus
How long to restrict from sports in Kawasaki with no CAD
6-8 weeks
