Cardiac Flashcards
What is Kawasaki disease?
A type of vasculitis
Mainly affecting the coronary arteries
Also affects large/medium vessels
Typically 6m-4yrs
What causes Kawasaki disease?
Unknown
Genetics
Infection: Strep/Staph
Autoimmune
What is the pathophysiology of Kawasaki disease?
Immune mediated breakdown of endothelial tissue in arteries
Exposes Tunica Media
What are the complications of Kawasaki disease?
Most common cause of acquired heart disease in the UK Coronary aneurysm MI Sudden cardiac death Ischaemia Arrhythmia HF Myocarditis Renal: Urethritis & sterile pyuria CNS: Aseptic meningitis
How is Kawasaki disease treated?
Self-limiting: 25% chance of heart complications
High dose IV immunoglobulin 2g/kg
Aspirin 80-100mg/kg/day
What is the issue with giving a child Aspirin?
Can cause Reye’s syndrome
Benefits of Aspirin outweigh risk of Reye’s syndrome
What are the signs & symptoms of Kawasaki disease?
CRASH & BURN
C-Conjunctivitis: Limbus sparing
R-Rash: All over body, polymorphous leading to desquamation (flakes off)
A-Arthritis/adenopathy: Enlarged cervical lymph nodes
S-Strawberry Tongue: Red mouth & throat
H-Hands & feet: Swollen & red palms & soles
Burn= Fever: Doesn’t resolve with antipyretics >38.5 for 5d
How is Kawasaki disease investigated?
No specific investigation Bloods: Inc ESR, CRP, Clotting, FBC (anaemia & leucocytosis) Urine culture: Can get proteinuria ECG: Normal w/strain infarcts ECHO: Look for aneurysm!
How is a diagnosis of Kawasaki disease made?
Child with an unexplained fever
AND
CRASH Symptoms: MUST have 4/5 symptoms
What is an innocent murmur?
Due to normal flow
Can be pronounced in minor illness
Can move when sitting/standing/breathing
How is an innocent murmur characterised?
Soft Systolic Short Symptomless Sternal edge (Left) No thrills
How can a murmur be split into?
Cyanotic: RIGHT to LEFT shunt- Poor! Tetralogy of fallout Transposition of the great vessels Non-cyanotic: LEFT to RIGHT shunt Coarc ASD/VSD/AVSD Patent ductus arteriosus
What is ToF?
What are the symptoms?
What is the management?
4 characteristics: 1) VSD 2) Overiding aorta 3) Pulmonary stenosis 4) RV hypertrophy Murmur: Loud, long ejection systolic in 3rd intercostal space Boot shaped heart Symptoms: Blue baby, tet spells (baby crying loads then turn blue), FTT, squatting baby, SOBOE Mx: Surgically in 1st year of life
What is transposition?
What are the symptoms?
What is the management?
Pulmonary artery & aorta swap
Symptoms: day 2-3 of life blue, duct dependant!
CXR: Narrow mediastinum, w/egg-on-side appearance
Mx: Keep ductus arteriosus open (prostaglandin infusion) & stabilising surgery
What is coarctation of the aorta?
What are the symptoms?
Is it associated with anything?
What is the management?
Narrowing of the aorta usually just distal to subclavian
Symptoms: Dependent on location, acute HF w/weak femoral pulses (BP higher in arms than legs)
Associated: Turner’s & berry aneurysm
CXR: Rib notching (development of large collaterals posterior to ribs)
Mx: Surgical ligation, balloon dilatation
What is ASD?
What are the symptoms?
What is the management?
Is it associated with anything?
Defect in atrial wall
Types: Ostium Secundum, Ostium Primum
symptoms: L > R shunt, Children usually well
Murmur: Widely split S2, ejection systolic best heard in 3rd L intercostal space, rumbling
Mx: Conservatively or percutanious surgery
Associated: Trisomy 21
What is VSD?
What are the symptoms?
What is the management?
Is it associated with anything?
Hole in ventricular septal wall
L>R shunt, FTT, SOBOE, asymptomatic,
Large: SOB, difficulty feeding, excess sweating, Rx resp infections, FTT)
Murmur: Ejection systolic (small), pan systolic (large)
Mx: Diuretics, ACEi, Surgery
Associated: Trisomy 21, eisenmengers (baby HF)
What is Patent ductus arteriosus?
What are the symptoms?
What is the management?
Is it associated with anything?
L >R shunt, usually asymptomatic, FTT, resp infections
Murmur: Machinery murmur inferior to left clavicle
Mx: Surgical ligation, Indometacin (prostaglandin inhibitor), Ibuprofen
What is Eisenmenger’s syndrome?
Irreversible pulmonary HTN w/reversal of shunting (R>L)
