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Pedia > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

> 5 years
Male predominance

Dreaded Carditis
Chronic valvulopathy

A

RF/RHD

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2
Q

<5 years

Dreaded vasculitis, coronary aneurysm and thrombosis

A

Kawasaki disease

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3
Q

Systemic vasculitis
Inflammation of small to medium-sized arteries with resulting aneurysm

Febrile mucocutaneous illness of childhood
Fever and rash

A

Kawasaki disease

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4
Q

Leading cause of acquired heart disease in children in developing nations

A

Rheumatic fever/ RHD

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5
Q

Most important manifestation of Kawasaki

A

Aneurysmal involvement of coronary arteries

Peak mortality 15-45 days after onset of fever with mortality rate ranging 0.08-3.7%

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6
Q

Greatest risk of cardiac involvement in Kawasaki occur in

A

<1 year

Atypical

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7
Q

Etiology of Kawasaki

A

Infection
Superantigen-driven response (genetic predisposition -> oligoclonal conventional antigen vs polyclonal)

Increased production of cytokines and MMP

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8
Q

Kawasaki Phases

A

Early - first day of high fever, swelling of endothelium and edema of media, intact IEL

SubAcute (7-9d) - influx of neutrophils, CD8+, cytotoxic lymphocytes and IgA producing plasma (IEL fragmentation, vascular damage, dilatation, aneurysm)

Convalescent (>10d) increase cytokines, IL, MMP (fibrosis)

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9
Q

IV IG in Kawasaki is best given between

A

6th-10 days of illness because of inflammation

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10
Q

Kawasaki Disease criteria

A

Fever >5 days and
4/5 Main clinical features after exclusion

or

> 4 principal criteria at day 4 of fever

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11
Q

Principal features of Kawasaki

A

Acute: Changes in extremities (erythema of palms, soles; edema of hands)

Subacute: periungal peeling of fingers, toes in weeks 2 and 3

Polymorphous exanthem

Bilateral bulbar conjunctival injection without exudates

Changes in lips and oral cavity: erythema, lips cracking, strawberry tongue, diffuse injection of oral and pharyngeal mucosa

Cervical lymphadenopathy 1.5 cm unilateral

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12
Q

Patients with fever of at least 5 days and <4 principal criteria can be diagnosed with KD when

A

coronary artery abnormalities are detected by 2D ECHO or angiography

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13
Q

If patients have at least 3/5 but present with this symptom, KD is disgnosed

A

Coronary artery disease

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14
Q

High grade fever with or without other manifestations (arthritis, myocarditis)
Lips and mucocutaneous changes
Cervical adenitis
Normal CBC

A

Acute phase

first 10 days

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15
Q 
Thrombocytosis
Desquamation of skin and palms
Beau’s lines 
With or without aneurysm
Coronary thrombosis
Mitral insufficiency
A

Subacute phase

11-22 days p

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16
Q

Cause of death in acute phase of KD

A

Myocarditis

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17
Q

Cause of death in subacute phase of KD

A

MI
Rupture of aneurysm
Myocarditis

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18
Q

May still be with Thrombocytopenia
Arthritis
Coronary and peripheral aneurysm

A

Convalescent phase

Cause of death: MI, IHD

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19
Q

Angina pectoris

MI

A

Chronic phase

20
Q

Fever responds to this in KD

A

IVIG

21
Q

Polymorphic exanthem on perineum mistaken for diaper rash

Dry erythematous, fissured, swollen and cracking lips

Strawbery tongue

Painful erythema and edema of extremity

Bilateral non exudative conjunctivitis

Unilateral Non-suppurative Cervical Lymphadenopathy >1.5 cm o

A

Fever >5 d
4/5

Kawasaki disease

22
Q

Valvular regurgitation because of ischemia of papillary muscles in KD occurs in

A

Mitral

Aortic

23
Q

Kawasaki disease Tx

A

IVIG (modulate cytokines, neutralization of bacterial super antigens)
Aspirin

Dipyrimadole if viral infection or hypersensitive (PDE 3 inhibitor antiplatelet)

24
Q

Peaks 11-15 years

Inflammatory process mediated by immunologic reaction initiated by GABHS

A

Rheumatic fever

25
Q

Most frequent GABHS serotype causing RF

A

M type 1.3.5.6.18

26
Q

Proves you had a strep infection within the last 2-6 weeks

A

ASO titer

27
Q

Specific HLA associated with RF/RHD

A

HLA DR4

HLA DR2

28
Q

Tropic for throat rather than skin
M Protein
Hyaluronate capsule

Can produce lipoprotein lipase (opacity factor) highly contagious

A

GABHS M strain

Lancefield A

29
Q

Latent period of RF

A

1-3 weeks

Antibody-induced immunological damage

30
Q

Strep infection affects susceptible host positive for

A

D8/17

31
Q

Universal heart finding in rheumatic carditis

A

Endocarditis

Carditis is the only manifestation that leaves a sequalae and permanent damage to the organ

32
Q

Girls 15-18 years

6-12 days after attack of RF

Clumsiness
Deterioration of hand writing
Emotional lability of grimacing of face

Stress and disappears with sleep

+ anti neural ab in 90%

Latency of 1-6 months

A

Chorea in RF

33
Q

Transient, serpiginous-looking lesions
Pale center, erythematous, non-prurituc, irregular margin
Trunk and limbs

Worsens with application of heat
Disappears with exposure to cold

A

Erythema marginatum of RF

34
Q

Hard, painless, pea sized, palpable nodules
Over extensor surfsces
Always associated with severe carditis and higher moratality rate

A

Subcutaneous nodules of RF

35
Q

Jones Minor criteria of RF

A

Fever
Arthralgia

Inc ESR and CRP
Leukocytosis

Prolonged PR interval

36
Q

Jones Criteria Diagnosis for RF

Major

A 
Polyarthritis major joints (migratory) 
Erythema marginatum
Carditis
Chorea
Subcutaneus nodules
37
Q

Supportiving evidence of RF

A

+ Throat culture or elevated rapid streptococcal antigen test

Inc or rising streptococcal antibody titer of at least 2 fold from baseline

38
Q

Diagnosis of RF

A

Two Major

1 Major + 2 minor

Evidence of Group A (culture, Rapid antigen, antibody titer)

39
Q

Post strep arthritic condition that doesn’t fulfill Jones criteria

Additive vs migratory joint pains
Poor response to salicylate and NSAID

Inc APR
+ ASO
May develop mitral disease

A

Poststreptococcal Reactive Arthritis

40
Q

Primary Prevention of RF

A

Benzanthine Pen G IM once
Pen V Oral 10d

If allergic
Erythromycin estolate PO 10d
Ethylsuccinate PO 10d

41
Q

Tx for Arthritis prominent RF

A

Aspirin

42
Q

Tx for carditis prominent RF

A

Prednisolone

Aspirin

43
Q

Secondary prophylaxis for RF

Mainstay management to prevent progression to heart djsease

A

Benzanthine Pen G 1.2 IM
Pen V PO
Sulfadiazine POV

44
Q

Low risk group
(Fever, joint pains and without confirmed carditis)

Give medication

A

Every 28 d until 5 years

Every 28 d until 21 years if with carditis

45
Q

For high risk grouos
(Heart involvement, heart failure, multiple valve involvement and recurrence)

Give medication

A

Every 4 weeks up to 25 years if mild (single valve)

Every 3 weeks up to 25 years if severe (decrease to every 4 unless recurrence)

For life if with cardiac pathology, stop at 40 if surgically managed

46
Q

Most common involved valve in RF Carditis

A

Mitral (85%)

Aortic (54%)

47
Q

Small joints
Symmetrical
Unresponsive to anti-inflammatory
Leaves a sequela (enlargement of joints after inflammation) - deformity of joints

A

Juvenile Rheumatic Arthritis

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