Pediatric Cardiology II - Nazeri Flashcards
Kawasaki Disease aka infantile polyarteritis nodosa*
- most common heart disease in children
- arteritis* –> mainly coronary arteries*
- <5 y/o (more common in boys)
- higher in Asians*
- high fever lasting 1-2 weeks*
- ECHO most used due to lack of tapering of arteries
- can form aneurysms (measured with Z score)
- z score >/= 10 –> giant aneurysm and need anticoagulation
- no live vaccines if on aspirin to avoid Reye syndrome (encephalopathy)
hallmarks***
- bilateral non-exudative conjuctivitis
- strawberry tongue
- edema/erythema of hands/feet
- various rashes
- non-suppurative cervical lymphadenopathy (unilateral)
- maybe desquamation
- low mortality, usually return to normal
labs
- high platelet count is giveaway***
- high ESR/CRP
- CSF pleocytosis*
- normal WBCs
treat
- IVIG and high dose aspirin (anti-inflammatory) –> reduces risk of CAA
- start anticoagulation aspirin later
- give 2nd dose of IVIG if fever persists for 36 hr. after 1st IVIG infusion (IVIG resistant KD)
KD clinical phases
- acute - fever and other symptoms for 1-2 weeks
- subacute - desquamation, thrombocytosis, CAA* develop
- convalescent - clinical signs disappear, high ESR/CRP persist
management of KD aneurysms
- small, single aneurysm –> remain on aspirin
- multiple, large aneurysms –> need anticoagulants
- may need surgery –> recannulate coronary arteries or bypass graft
rheumatic fever
- acute migratory arthritis from GAS pharyngitis**
- decreased incidence due to antibiotic use
- most common acquired heart disease in all age groups*
hallmarks** JONES**
- polyarthritis (migratory)
- carditis
- subcu nodules (erythema nodosum)
- erythema marginatum
- chorea
primary prevention
-10 day course of oral penicillin to treat GAS (erythro/azithro/clindamycin if allergic)
secondary prevention
- no carditis in 1st attack –> antibiotics until 21 or 5 years after 1st attack bc of high recurrence
- if carditis in 1st attack –> antibiotics until adult or rest of life
how to look for prior GAS
- throat culture
- rapid strep antigen test
- elevated ASO titer
migratory arthritis in ARF
- most common
- large joints (swollen, tender)
- multiple joint involvement
- severity of arthritis is INVERSELY related to cardiac issues*** (ex. severe arthritis –> mild carditis and vice versa)
carditis in ARF
- 2nd most common
- usually has tachycardia and systolic murmur
- pancarditis, but MUST have endocarditis (valvulitis) for RF***
- usually viral if endocarditis is not present
- mitral valve most common** followed by aortic
- acute phase –> mitral insufficiency –> holosystolic murmur
- severe cases –> mitral stenosis –> mid-diastolic murmur
- aortic insufficiency –> decrescendo diastolic
sydenham chorea
- movement disorder, disappears with sleep
- milkmaid’s grip, darting movement of tongue
- chance of developing RHD in 20 years if not given secondary prevention
mitral insufficency
-can lead to Afib, cardiac failure, infective endocarditis
treat
- after load reducing agents (ACEI, ARB)
- valve replacement
-if prosthetic mitral valve present, prophylaxis against bacterial endocarditis with dental procedures*
mitral stenosis
-build up pressure in LA –> LA hypertrophy –> redistribute pulmonary blood flow** –> pulmonary HTN and right side heart failure
treat
-valvotomy, balloon catheter, valve replacement
aortic insufficiency
- volume overload –> dilation of LV –> can lead to mitral insufficiency
- does not regress***, just like mitral stenosis cannot regress (mitral insufficiency can)
aortic stenosis
- treat with afterload reducing agents or valve replacement
- ST-T wave changes on EKG show decreasing LV ejection fraction
myocarditis
- inflammation of cardiac muscle
- usually due to viral infection*** (hepC in Asia)
- bacterial infection less common (diphtheritic myocarditis)
- could also be due to connective tissue disorder
- bad if progresses to chronic myocarditis
symptoms
-tachycardia, gallop rhythm*, hypotension
- more severe in infants –> death
- more mild in older children/adolescents –> may need heart transplant if present with other cardiomyopathy or if symptoms worsen
cardiac MRI is standard for diagnosing**
pericarditis
- fluid accumulation in outer sac
- small fluid –> well tolerated
- moderate fluid –> sharp chest pain (worse with inspiration), cough, dyspnea, fever
- mostly viral*
-can lead to cardiac tamponade***
non-infectious pericarditis
-postpericardiotomy syndrome after cardiac surgery –> fever, lethargy, anorexia, pleural effusion
constrictive pericarditis
- fibrous thickening and calcification –> impairs distensibility and venous return
diagnosis**
- low QRS amplitude on EKG***
- water bottle appearance on chest Xray*
treat
-non steroidals, pericardiocentesis for tamponade, pericardiectomy for constrictive
cardiac tamponade
- too much fluid in pericardial sac compresses RA and RV reducing venous return and BP
- impair filling –> shock and sudden death*
- pulsus paradoxus –> fall of BP >10mmHg on deep inspiration
