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32 Cards in this Set
- Front
- Back
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Kawasaki Syndrome
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-Most common cause of acquire heart disease in children
-Recognized in 1967 -Acute self limiting vasculitis of unknown etiology -76% in children < 5 years of age -Boys > girls -Asians and blacks > whites (9 & 1.5: 1) |
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Kawasaki – Clinical Manifestations
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**Fever >5 days**
Polymorphous rash Erythema of oral membranes Indurative edema of hands and feet Cervical lymphadenopathy Non-purulent conjunctivitis Acute and often toxic presentation |
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Clinical Manifestations contd
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Coronary artery aneursyms and ectasia in 15-25% of untreated cases
May lead to myocardial infarction, sudden death, or ischemic heart disease High risk Children < 1 year of age Males |
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Kawasaki – Laboratory Anomalies
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Elevated acute phase reactants
Elevated ESR Elevated platelets Elevated WBC count Elevated liver transaminases |
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remember the picture of the kids tiny fingers with skin peeling from around the paronychia...
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edema desquamation
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EKG in 7 yr old with Kawasaki
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Kawasaki Treatment (know this slide!!!!!)
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-IV Gamma globulin (IV IgG)
2 gm/ kg over 24 hours -Aspirin --20 - 25 mg/kg/dose q6hrs until afebrile 2-3 days --3-5 mg/kg/day 6-8 weeks until ESR and platelet count is normal |
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Kawasaki Buzzwords for Exams
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-Febrile child, not responding to antibiotics
-Usually a toddler -Acute fever of AT LEAST FIVE DAYS -Must have four of these: Cervical adenopathy Dry/fissured lips or swollen tongue Conjunctivitis Polymorphous exanthem Erythema/induration leading to desquamation of hands and feet |
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Kawasaki Buzzwords for Exams
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-Dx cannot be made with < 5 days of fever
-One of few reasons EVER to treat a child with Aspirin I--nitially high dose (80-100 mg/kg/day) -Cardiomegaly is NOT a sign of Kawasaki -Easily confused with: --Drug reactions (no fever) --JRA (chronic low grade temp, rash when fever peaks) --Measles (rash different, measles has exudative conjunctivitis) |
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Rheumatic Fever/Heart Disease
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-Second common acquired heart disease in childhood
-Post-infectious connective tissue response in susceptible host -Latency period of 3 weeks -Untreated Group A b- hemolytic streptococcus of the pharynx -Does NOT follow group A strep infections at other sites -1/3 of patients have a mild, almost asymptomatic pharyngitis |
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Rheumatic Fever: High risk groups
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High family incidence
Children ages 6-15 years Low socioeconomic status |
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Jones Criteria: major
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MAJOR
Arthritis - 65 - 85% Carditis - 60% Chorea - 20% Erythema Marginatum - 6% Subcutaneous nodules - 5% |
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minor
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Arthralgia
Fever of 38 C Elevated ESR, C-reactive protein Prolonged PR interval |
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Diagnosis
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***Must have evidence of an antecedent strep infection
History of recent scarlet fever Positive throat culture Elevated ASO Streptozyme test |
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Carditis (know this slide)
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-Occurs 1-2 weeks after strep infection
-Inflammation of endocardium, valves, myocardium, and/or pericardium -Prior attack increases risks of recurrence --Mitral Valve - most common Insufficiency Congestive heart failure Stenosis, occurs years later --Aortic Valve Insufficiency less common but more severe |
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Sydenham’s Chorea
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St. Vitis’ Dance
Purposeless, choreiform movements Aggravated by stress Emotionally labile |
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Erythema Marginitum
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Characteristic rash
Rarely seen in other disease Nonpuritic, macular rash Serpiginous border surrounding normal skin Seen on trunk and proximal limbs Not face Accentuated by warmth |
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Subcutaneous Nodules
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Rare
Seen in chronic rheumatic heart disease Located on **extensor** surfaces of joints elbows, knuckles, knees, ankles Sometimes on scalp and spine Painless, freely movable 0.5-2 cm in size |
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Diagnosis
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2 major criteria and 1 minor criteria
OR 1 major criteria and 2 minor criteria Plus Supporting evidence of an antecedent Group A strep infection |
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Rheumatic Fever: Treatment (know this slide)
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Supportive care
Bed rest Treat strep infection Anti-inflammatory agents Aspirin 100 mg/kg/day divided in 4-6 doses Prednisone 2 mg/kg/day divided in 4 doses Reserved for severe cases of carditis |
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Rheumatic Fever Prophylaxis
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To prevent recurrence
Penicillin VK 250 mg bid Sulfadiazine 0.5 to 1 gm qd Erythromycin 250 mg bid LA bicillin 1.2 million units IM q 28 days Until age 21-25 if no carditis Not in a high risk group* For life for rheumatic carditis *teachers, military, medical profession |
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SBE Prophylaxis (subacute endocarditis)
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In addition to Rheumatic prophylaxis IF there is Rheumatic heart disease
-Clinidamycin 600 mg ( 20 mg/kg) -Cephalexin 2 gm ( 50 mg/kg) -plus Gentamicin 1.5 mg/kg IV for GI/ GU procedures |
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2007 SBE Prophylaxis
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-Prosthetic cardiac valve
-Previous infective endocarditis -Congenital heart disease --Unrepaired cyanotic CHD --CHD with prosthetic material or device during the first 6 months after the procedure --CHD with residual defects at or adjacent to a prosthetic patch or device -Cardiac transplant recipients with valve disease |
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Buzzwords for Rheumatic Fever
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-Murmur “heard best at the apex” = MR (mitral regurg)
-J♥NES help – pneumonic to remember criteria arthrITIS = major; arthrALGIA = minor -Rash is erythema MARGINATUM, but arthritis is MIGRATORY Erythema migrans = Lyme disease |
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Atherosclerosis
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Cardiovascular disease remains the most common cause of death in the United States
Atherosclerosis is a chronic disease process with origins in childhood The rate of disease progression is determined by the presence of known cardiovascular risk factors |
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Atherosclerosis
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Multiple studies have identified the risk factors that increase the incidence of coronary artery disease
Framingham Study Bogalusa Study PDAY (Pathobiological Determinants of Atherosclerosis in Youth) Muscatine Study These risk factors include; Family history of heart disease Reduced level of HDL – cholesterol Elevated serum cholesterol level Hypertension Cigarette smoking Impaired carbohydrate tolerance Lack of physical activity |
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picture time
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Red Flags
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Toddler of a normal weight parent
10% risk of obesity If one parent is overweight or obese Risk increases to 40% An overweight adolescent has a 70% chance of becoming overweight or obese adult |
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Prevention
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Most importantly, a healthy diet & increased physical activity for all children, including low-fat dairy products for all children over two years of age.
Low-fat dairy products for children 12 - 24 months who are overweight. Screening (a fasting lipid profile) - starting at age 2 years and then every 3-5 years - for all children and adolescents with a family history of high cholesterol / high fat levels or early cardiovascular disease. |
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Prevention
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Screening for all children whose family history is unknown or who are overweight, have high blood pressure, or diabetes.
Weight management should be the primary treatment for overweight kids with high lipid levels. For patients 8 years and older with an LDL concentration greater than 190 mg/dL (or 160 mg/dL with a family history of early heart disease or two additional risk factors present; or 130 mg/dL if diabetes is present), medications should be considered. |
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A 12-year-old girl presents to your office for the first time with a swollen, painful, erythematous right knee joint. She tells you that her left knee felt and looked similar yesterday, but now feels normal. She also is easily fatigued and has had fever. On physical examination, she has a temperature of 101.7°F (38.7°C), a heart rate of 125 beats/min, a respiratory rate of 24 breaths/min, and a blood pressure of 120/78 mm Hg. Her lungs are clear. On auscultation, you note a 3/6 holosystolic murmur at the cardiac apex with radiation to the axilla.
a. antibiotic therapy with doxycycline b. anti-inflammatory therapy with aspirin c. aspiration of the right knee d. heat, elevation, and splinting of the right knee joint e. immunotherapy with azathioprine |
Anti-inflammatory with aspirin for rheumatic fever
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A 3-year-old girl is brought to your office for re-evaluation of a fever that began 6 days ago. Her mother tells you that her daughter's temperature has been as high as 102.2°F (39°C). Her physical examination was unremarkable when you examined her 3 days ago, but today you note injected sclera; cracked, red lips; a strawberry appearance of her tongue; and a swollen, nontender, cervical node.
a. an exercise stress test should be performed as a baseline study b. aspirin therapy will be used until the fever subsides c. cardiac involvement may include abnormalities of the coronary arteries or the myocardium d. echocardiography should be performed to evaluate for the presence of coronary aneurysms e. immediate treatment with intravenous immune globulin will eliminate the chance of coronary involvement |
aspirin, kawasaki
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