Cardiology Flashcards
What is Kawasaki disease?
systemic vasculitis
What is the peak age of Kawasaki disease?
18-24m
In what races is Kawasaki disease more common?
Japanese
afrocaribbean
What are the diagnostic criteria for Kawasaki disease
≥5 day fever + at least 4 of the following:
- bilateral non-exudative conjunctivitis
- Cervical lymphadenopathy
- Polymorphous rash
- Mucositis - strawberry tongue
- Red and oedematous palms and soles w peeling of fingers and toes
What is an important complication of Kawasaki diseasE?
aneurysm of the coronary arteries - can be fatal!!
What are the Ix for Kawasaki diseasE?
- increased WCC - neutrophils
- Increased platelets in 2nd week
- increased ESR/CRP
- serial echos for aneurysm or angiography to be accurate
What is the treatment of Kawasaki disease?
IVIG - single dose within first 10 days
Aspirin to decrease risk of thrombosis
If non-responsive to initial dose - prednisolone
Why is aspirin usually contraindicated in children?
due to the risk of Reye’s syndrome
What is the cause of rheumatic fever?
In susceptible individuals, there is an abnormal immune response to a preceding infection with group A beta-haemolytic strep
What age does rheumatic fever mainly affect?
5-15yrs
What is the major concern of rheumatic fever?
can cause permanent damage to the heart valves
Where is rheumatic fever common?
in developing countries
Give the name of the criteria used to diagnose rheumatic fever
Jones criteria
give the major criteria for a diagnosis of rheumatic fever
- polyarthritis - migratory
- pancarditis - 1 of: CCF, cardiomegaly, friction rub, +ve echo
- Sydenham chorea - involuntary movements and emotional lability for 3-6m, 2-6m after the inf.
- erythema marginatum - rash on trunk + limbs
- subcut nodules
What are the minor manifestations of rheumatic fever?
- fever
- arthralgia (pain but not swelling)
- Hx of rheumatic fever/HD
- Raised ECR (>20mm), CRP, WCC
- ECG - PR interval >0.2S
What must be fulfilled in the criteria for a diagnosis of rheumatic fever?
2 major
1 major and 2 minor
PLUS evidence of preceding group A strep infection (scarlet fever, throat swab or serum titre)
What is the management of an acute episode of rheumatic fever?
- bed rest, limited exercise
- aspirin
- prednisolone for fever and inflammation
- Pericardiocentesis for pericardial effusions
- diuretics and ACEi for symptomatic HF
What is the appropriate management for preventing recurrence of rheumatic fever
Benzathine penicillin
OR
phenoxymethlypenicillin
What is the most common long term consequence of chronic rheumatic heart disease?
mitral stenosis from scarring and fibrosis of the valve tissue
What is chronic rheumatic heart disease?E
Refers to long term cardiac damage caused by a single severe episode or multiple recurrent episodes of
What is eisenmenger syndrome?
reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension.
What heart defects lead to eisenmenger syndrome?
VSD
ASD
PDA
What are the clinical features of eisenmengers?
original murmur may disappear cyanosis clubbing right ventricular failure haemoptysis, embolism
What is the management of Eisenmenger syndrome?
heart-lung transplant
What is the most common cause of infective endocarditis?>
alpha-haemolytic strep - strep viridans
What CHD puts children at risk of infective endocarditis?
VSDs, COA, PAD, prosthetics
i.e. when there is a turbulent jet of blood
What sx should raise suspicion of infective endocarditis?
sustained fever malaise increased ESR unexplained anaemia haematuria (microscopic)
What are the signs of infective endocarditis?
fever splenomegaly CLUBBING SPLINTER HAEMORRHAGES anaemia, haematuria rash HF new murmur
what are ix for infective endocarditis?
Blood cultures
Echo
What is the treatment of infective endocarditis?
6 weeks IV therapy of high dose penicillin w amino glycoside
I.E.
IV benzylpenicillin 25mg/kg/4hr
+ gentamicin
What is recommended for prophylaxis of infective endocarditis?
good dental hygiene
