Pediatric Acquired heart Disease

Question 1

Kawasaki Disease

Answer 1

Acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age

Question 2

Clinical diagnosis of KD - Warm CREAM

Answer 2

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

Question 4

pathogenesis of KD

Answer 4

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

Question 5

note- basculitis is a common but non-specific symptosm and signs

Question 6

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 :

Answer 6

coronary artery enlargemend. higher sik for sudden death, anigina, MI and arrythmia

Question 7

2 key treatments for kawasaki’s disease

Answer 7

1. IVIG- high dose to reduce the incidence of aneurysms
2. 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.

Question 8

natural history of the aneursyms in KD

Answer 8

1. around 50% of aneurysms regress with treatment– but likely abnormal vascular function
2. higest risk: giant aneurysms >8 mm. thrombosis, stenosis, pediatric myocardial infarction can happen
3. myocardial dysfunction, valve regurgiation, aortic abnormalities.

Question 9

most common cause of acquired pediatric heart disease

Answer 9

acute rheymatic fever. disease of childhood. more common developing country

Question 10

most common bacteria cause of acute rheumatic fever

Answer 10

groupA strep (strep pyogenes) most common.

Question 11

major criteris (jones) to dx rheumatic fever

Answer 11

Major Criteria

• Carditis • Chorea • Polyarthritis • Erythema marginatum • Subcutaneous nodules

Question 12

minor criteria for acute rheumatic fever

Answer 12

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

Question 13

acute rheumatic fever can cause carditis. what valve is most affected bt ARF

Answer 13

1. mitral regurgitation )or mitral stenosis in adults)

2 . aortic regurgitation

• can cause anywhere from a murmur to critical heart failure.

Question 14

treatment of ARF

Answer 14

1. antibiotic treatment– consider penicillin
2. arthritis management with NSAIDs
3. carditis management (valve treatment)
4. secondary prophylaxis and education

Question 15

Rheumatic heart disease is a common consequence of ARF. it’s more long lasting than ARF.

2 valves affected by RHD

Answer 15

1. chronic mitral regurgitation ( mitral stenosis in older adults)
2. chronic aortic regurgitation
   - more severe with recurrent episodes of ARF

Question 16

characteristic sound produced in pericarditis

Answer 16

FRICTION RUB

Question 17

Answer 17

acute pericarditis

Question 18

main causes of percarditis

Answer 18

1. bacterial causes– staph A, haemophilus influenzae, strep.
2. viruses; adenovirus, influenza virus, rubella, mumps
3. other– syphillus, candida, oxoplasma gondii

Question 19

treatment for viral pericarditis

Answer 19

• nsaids and colchicine

Question 20

treatment for bacterial pericarditis

Answer 20

Question 21

causes of pericardial effusion in kids

Answer 21

viral is super causes.

consider KD.

consider malignancy

Question 23

cardiac tamponade presentation features

Answer 23

1. tachycardia
2. tachypnea
3. narrow pulse pressure (systolic pressure and diastolic pressure are similar, because even at “rest,” the pressure is high)
4. pulsus paradoxus

Question 24

Note about myocarditis

Question 25

What is being seen here?

Answer 25

there is increased edema in the left ventricle, and can see inceased fibrosis

Question 26

in myocarditis, the heart can “burn out” and cause ___ cardiomyopathy

Answer 26

dilated cardiomyopathy.

Question 27

Question 28

main cause of dilated cardiomyopathy in children

Answer 28

1. myocarditis
2. familial
3. neuromuscular

Question 29

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.

Answer 29

huge P wave- right atrial dilation

in V2, theres ST elevation

• kids don’t usually get MIs, so it might be dilated

Question 30

Many aspects of IE are similar in children and adults, but there are some manifestations that are unique to children.

Question 31

key causes of infectious endocarditis

Answer 31

GRAM POSITIVE MORE COMMON THAN GRAM NEGATIVE
- streptococci (alpha hemolytic)

• staphylococci

Question 32

clinical and lab findings in IE

Answer 32

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

Question 33

Jones criteria diagnoses ____

and Duke Criteria diagnoses ___

Answer 33

jones = acute rheuamtic fever

dule = infectious endocarditis

Question 34

first thing to do when suspecting infecitous endocarditis

Answer 34

blood cultures

Question 35

modified fuke criteria for IE

Answer 35

• need a positive blood culture with an organisms that is consistent with IE
• positive echocardiogram
• valve regurgitation
• fever, likelyhood, vascular phenomena

Question 36

treatment for IE

Answer 36

1. prolonged IV antibiotics
   - usually involves a prolonged hospital stay 4-6 weeks. antibiotics is determined by organism
2. may require CV surgery

- dental prophylaxis is recommended if they have a prosthetic cardiac valve, previous infectious endocarditis, congenital heart disesaes.