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Peds - Spring 2016 > Acquired Heart Diseases - Unit 4 > Flashcards

Acquired Heart Diseases - Unit 4 Flashcards

1
Q

Kawasaki disease - leading cause of heart disease in children. T/F?

A

TRUE

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2
Q

Rheumatic fever - autoimmune response to group A beta-hemolytic streptococci (about _ to _ weeks after)

A

2-6 weeks.

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3
Q

If there a difference between rheumatic fever and rheumatic heart disease?

A

YES - rheumatic heart disease occurs when rheumatic fever causes damage to the valves of the heart.

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4
Q

why is rheumatic fever an uncommon illness in developed countries today?

A

Antibiotic therapy! (thank god!)

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5
Q

where are the manifestations of rheumatic fever mainly seen?

A

Heart, joints, skin, CNS

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6
Q

what are aschoff bodies?

A

lesions that are found in all patients with rheumatic fever. Cause swelling and changes in connective tissue. Found in the heart, blood vessels, brain, joints, pleura, etc.

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7
Q

The mitral valve is the area of the heart that is affected most often in rheumatic fever, so a child with an ____ systolic murmur may have mitral regurgitation.

A

apical systolic murmur.

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8
Q

what are some manifestations of cardiac involvement?

A

tachycardia that is greater than the expected for a child with a fever, signs of heart failure, cardiomegaly, muffled heart sounds (due to pericarditis), chest pain

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9
Q

what are some other manifestations of cardiac involvement?

A

polyarthritis, erythema marginatum, subcutaneous nodules, chorea

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10
Q

what is polyarthritis?

A

swollen, hot, and red - usually affects knees, elbows, hips, shoulders, and wrists - aka the large joints! it works its way up.

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11
Q

what is erythema marginatum?

A

rash noted on trunk and proximal areas of extremities - reddened with a clear center and wavy border THAT DOES NOT ITCH!

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12
Q

what are subcutaneous nodules?

A

Rare, small, nontender nodules that may be found in clusters over bony prominences (knees, wrists, elbows)

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13
Q

What is chorea?

A

Sudden, aimless, irregular movements. can affect speech, extremity movements, can last months, etc.

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14
Q

What worsens chorea? what gender is it typically seen in?

A

Anxiety and deliberate attempts at fine motor activity. Chorea is seen mostly in female children.

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15
Q

what does an ASO titer indicate?

A

a recent streptococcal infection.

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16
Q

what is the jones criteria?

A

diagnosing rhemeuatic disease…MUST have 2 major or 1 major and 2 minor and evidence of a recent strep infection.

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17
Q

What are major things for the jones criteria?

A

Carditis, polyarthritis, erythema marginatum, subcutaneous nodules.

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18
Q

What are minor things for the jones criteria?

A

arthralgia, fever, increased ESR, increased CRP

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19
Q

how do we manage rheumatic disease?

A

Prevention (prevent strep infections!), prevention recoccurences, penicillin

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20
Q

once a child has had rheumatic fever, they are immune for life. T/F?

A

FALSE - they are actually more susceptible to recurrent rheumatic fever and they may need prophylactic antibiotics.

21
Q

can we give aspirin to kids with rheumatic disease?

A

YES

22
Q

when can the child with rheumatic fever resume moderate activity?

A

when the fever subsides.

23
Q

what rhythm might be seen in the child with rheumatic fever?

A

Atrial fibrillation

24
Q

what is another name for infective endocarditis?

A

Bacterial endocarditis.

25
Q

what is infective endocarditis?

A

infection of valves and inner lining of heart.

26
Q

Who is at risk for infective endocarditis?

A

children with heart defects, children who have had heart surgery, children who have had rheumatic heart disease, and children with invasive devices.

27
Q

Infective endocarditis has increased in pediatrics in recent years - T/F?

A

TRUE - it is thought to be due to the increased survival of children with heart defects.

28
Q

how does infective endocarditis occur?

A

Microorganisms grow on a section of the endocardium that has experienced abnormal blood flow.

29
Q

What are some signs/symptoms of infective endocarditis?

A

Unexplained low grade intermittent fever, malaise, headache, diaphoresis, weight loss, murmur changes, emboli formations

30
Q

What are some emboli formation signs for infective endocarditis?

A

splinter hemorrhages, osler nodes, janeway spots, petechiae on oral mucus membranes.

31
Q

what are splinter hemorrhages?
Olser nodes?
janeway spots?
petechiae?

A

what are splinter hemorrhages - little black lines under the nails.
Olser nodes - painful raised red nodules.
janeway spots - painless hemorrhagic areas on palms and soles.
petechiae - little spots.

32
Q

how do we diagnose infective endocarditis?

A

ECG changes (AV block), elevated ESR, microscopic hematuria, 3 blood cultures, echo (valvular insufficiency, vegetation, abscesses)

33
Q

why are 3 blood cultures recommended for diagnosing infective endocarditis?

A

To rule out ANY contamination or dilution that may have occurred during the collection phase.

34
Q

how do we treat infective endocarditis?

A

IV antibiotics (possibly as long as 2 months!), surgery, prevention (possibly antibiotics)

35
Q

who are high risk children that need prophylactic antibiotics prior to dental procedures?

A

Children with cyanotic defects that have not been repaired fully, children with defects that have been repaired with prothetic materials within the last 6 months, heart transplantation recipients.

36
Q

A child with an ASD is going to have his teeth cleaned. He is receiving an antibiotic for a UTI. Can he still have his teeth cleaned?

A

NO - it is best to wait until the antibiotics have been completed for 10 days to allow the normal flora to regenerate.

37
Q

what is kawasaki syndrome?

A

Vasculitis of the small and medium sized blood vessels. Progressive inflammation during the acute phase (dilation and enlargement of the vessels - aneurysm formation can occur!!)

38
Q

Kawasaki syndrome - thought to be related to what?

A

An infection!

39
Q

If 100 children with kawasaki disease were untreated, how many would develop cardiac sequelae?

Which blood vessels are most susceptible to damage?

A

20-25

Coronary (they supply the blood to the heart muscle)

40
Q

Is myocarditis seen early or late in kawasaki disease?

A

Very common in the EARLY phase.

41
Q

what are some clinical manifestations of kawasaki disease?

A 
High/persistent fever. 
Unresponsive to antibiotics or antipyretics
swelling of conjuctiva without drainage
rash
mouth/lips/tongue inflammation
swollen red hands/feet
irritability
inflammation
42
Q

what is the strawberry tongue?

A

Kawasaki - inflammation of the pharynx and the oral mucosa. Papillae of the tongue is exposed after the normal coating sloughs off.

43
Q

what type of vessel changes would be evident on echocardiogram on a child with kawasaki?

If a child develops the most serious complication of kawasaki, coronary artery aneurysms, he is at risk for what?

A

Dilation.

MI.

44
Q

what labs do we do for kawasaki?

A

Anemia, leukocytosis with a shift to the left (increased immature WBC’s), increased platelets

45
Q

how do we treat kawasaki?

A

IVIG (decreases coronary artery abnormalities when given within 7-10 days of symptoms), salicylate (high dose for inflammation followed by low dose until platelet count returns to normal)

46
Q

what are signs of aspirin toxicity?

A

tinnitus, headache, dizziness

47
Q

if the child is receiving aspirin/salicylate therapy, and they become infected with a virus, what should we do?

A

STOP THE ASPIRIN! they are then at risk for reye’s syndrome (brain swelling :( )

48
Q

once kawasaki disease resolves, the child is not at an increased risk for heart disease. T/F?

A

FALSE - arteries may be stiffer due to scar tissue formation - they should then always maintain a heart healthy lifestyle.

Peds - Spring 2016 (29 decks)

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