Pediatric Acquired heart Disease Flashcards
Kawasaki Disease
Acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age
Clinical diagnosis of KD - Warm CREAM
fever
c= conjunctivitis
R= rash
E= edema- on palms and soles
A= adenopathy
M = mucosal changes– strawberry tongue, red and fissured lips
****L = lymphadenopathy – unilateral and LARGE
pathogenesis of KD
can be caused by an initial infectious.
- abnormal immune response is provoked in a genetically susceptible host, resulting in microvasculitis, panarteritis, destructive changes and aneurysms
note- basculitis is a common but non-specific symptosm and signs
in KD, 30-50% of patients show diffusely enlarged ___ ___ in the acute phase.
-without tx, aneurysms develop within 1-3 weeks. Aneurysms may thrombose or become stenotic, resulting in risk of :
coronary artery enlargemend. higher sik for sudden death, anigina, MI and arrythmia
2 key treatments for kawasaki’s disease
- IVIG- high dose to reduce the incidence of aneurysms
- aspirin; anti-inflammatory, antipyretic and antiplatelet effects to prevent sudden thrombosis or stenosis
- – high-dose until afebrile for 48 h – low-dose for 4-6 weeks – longer for coronary dilation/aneurysm
- might include LMWH or warfarin if there is coronary dilation/aneurysm/need for longer term amangement.
natural history of the aneursyms in KD
- around 50% of aneurysms regress with treatment– but likely abnormal vascular function
- higest risk: giant aneurysms >8 mm. thrombosis, stenosis, pediatric myocardial infarction can happen
- myocardial dysfunction, valve regurgiation, aortic abnormalities.
most common cause of acquired pediatric heart disease
acute rheymatic fever. disease of childhood. more common developing country
most common bacteria cause of acute rheumatic fever
groupA strep (strep pyogenes) most common.
major criteris (jones) to dx rheumatic fever
Major Criteria
• Carditis • Chorea • Polyarthritis • Erythema marginatum • Subcutaneous nodules
minor criteria for acute rheumatic fever
Minor Criteria
• Fever • Arthralgia • Elevated acute-phase
reactants
– ESR, CRP • Prolonged PR interval
- primary RF episode = 2 major, or 1 major and 2 minor
- if a population is at high risk for ARF– consider monoarthritis as a major criteria and monoarthralgia as a minor criteria
acute rheumatic fever can cause carditis. what valve is most affected bt ARF
- mitral regurgitation )or mitral stenosis in adults)
2 . aortic regurgitation
- can cause anywhere from a murmur to critical heart failure.
treatment of ARF
- antibiotic treatment– consider penicillin
- arthritis management with NSAIDs
- carditis management (valve treatment)
- secondary prophylaxis and education
Rheumatic heart disease is a common consequence of ARF. it’s more long lasting than ARF.
2 valves affected by RHD
- chronic mitral regurgitation ( mitral stenosis in older adults)
- chronic aortic regurgitation
- more severe with recurrent episodes of ARF
characteristic sound produced in pericarditis
FRICTION RUB
acute pericarditis
main causes of percarditis
- bacterial causes– staph A, haemophilus influenzae, strep.
- viruses; adenovirus, influenza virus, rubella, mumps
- other– syphillus, candida, oxoplasma gondii
treatment for viral pericarditis
- nsaids and colchicine
treatment for bacterial pericarditis
causes of pericardial effusion in kids
viral is super causes.
consider KD.
consider malignancy
cardiac tamponade presentation features
- tachycardia
- tachypnea
- narrow pulse pressure (systolic pressure and diastolic pressure are similar, because even at “rest,” the pressure is high)
- pulsus paradoxus
Note about myocarditis
What is being seen here?
there is increased edema in the left ventricle, and can see inceased fibrosis
in myocarditis, the heart can “burn out” and cause ___ cardiomyopathy
dilated cardiomyopathy.
main cause of dilated cardiomyopathy in children
- myocarditis
- familial
- neuromuscular
Case
• 2 month-old previously well male infant
• 2 day history of increased WOB, lethargy and
poor feeding
• T 38.3°C HR 165 BP 80/p RR 60 SpO 2
96%
• Mild rhinorrhea, some accessory muscle use
• Normal heart sounds but apex displaced
laterally. Nomurmur.Hepatomegaly.
huge P wave- right atrial dilation
in V2, theres ST elevation
- kids don’t usually get MIs, so it might be dilated
Many aspects of IE are similar in children and adults, but there are some manifestations that are unique to children.
key causes of infectious endocarditis
GRAM POSITIVE MORE COMMON THAN GRAM NEGATIVE
- streptococci (alpha hemolytic)
- staphylococci
clinical and lab findings in IE
usually presents with nonspecific fuindins like arthralgia, petechia, might see osteomyelitis, stroke, septic emboli.
- less likely to see osler nodes and janeway lesions but still possible
Jones criteria diagnoses ____
and Duke Criteria diagnoses ___
jones = acute rheuamtic fever
dule = infectious endocarditis
first thing to do when suspecting infecitous endocarditis
blood cultures
modified fuke criteria for IE
- need a positive blood culture with an organisms that is consistent with IE
- positive echocardiogram
- valve regurgitation
- fever, likelyhood, vascular phenomena
treatment for IE
- prolonged IV antibiotics
- usually involves a prolonged hospital stay 4-6 weeks. antibiotics is determined by organism - may require CV surgery
- dental prophylaxis is recommended if they have a prosthetic cardiac valve, previous infectious endocarditis, congenital heart disesaes.
