Cardiology - other disease states

Question 1

What is Kawasaki disease?

Answer 1

acute febrile vasculitis in pediatric patients (< 2 y/o)

Question 2

Other names for Kawasaki disease

Answer 2

• Mucocutaneous lymph node syndrome
• Infantile periarteritis nodosa

Question 3

Complications of Kawasaki disease if left untreated

Answer 3

coronary artery aneurysms and/or death

Question 4

Work up for Kawasaki disease

Answer 4

• ECHO to see if coronary artery aneurysm is present
• lab to assess for inflammatory markers and urine protein levels

Question 5

Acute management of Kawasaki disease

Answer 5

• IVIG 2000mg/kg x 1 dose within 7-10 days of disease onset (suppressing immune system)
• Aspirin 81-100 mg/kg/day divided into Q6H x 14 days (or until afebrile x 48 hrs)
• ASA maintenance: 3-5 mg/kg/day once daily
• No coronary aneurysms: 6-8 wks of therapy
• Coronary involvement: lifetime

Question 6

For Kawasaki disease, what therapy can be added on if pt not responding to IVIG?

Answer 6

• prednisolone
• infliximab (Remicade) (TNF alpha antagonist)

Question 7

When would anticoagulation be appropriate in Kawasaki disease?

Answer 7

• If pt has very large coronary artery aneurysms; add warfarin (INR target 2-2.5) or LMWH on top of ASA
• If there is significant coronary involvement