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41 Cards in this Set
- Front
- Back
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what are the 7 basic etiologies of heart disease
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Infectious
Ischemic Inflammatory Traumatic Metabolic Hypertensive Nutritional |
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what is the most common cause of acquired heart disease in children?
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Kawasaki Syndrome
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patient has a fever for 5 days, the mom says it may have been more. On the 5th day a polymorphous rash popped up and they now have erythema of oral membranes. What do they have?
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Kawasaki syndrome
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pt is toxic looking and have purulent conjunctivitis and edema of the hands....what might they have
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kawasaki
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what heart problem can arise with Kawasaki syndrome? Who is at high risk for this
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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 High risk: Children < 1 year of age Males |
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what are some of the laboratory anomalies seen in Kawasaki
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Elevated acute phase reactants
Elevated ESR Elevated platelets Elevated WBC count Elevated liver transaminases |
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what will the EKG of a kid with Kawasaki look like?
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sinus tachycardia and flattened T waves
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how long does it take for heart problems to occur with kawasaki disease?
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anyeurism can occur at around day 12
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What is the treatment for Kawasaki?
*KNOW THIS SLIDE |
IV Gamma globulin
Aspirin (note, we are trying to stop coronary artery anyerism, this is one of the few times you use aspirin in kids!!!) ----start with heavy dose (until afebrile), then go small |
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what is Reyes syndrome
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give a kid aspirin and they go into liver failure and die
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You have a febrile toddler that does not respond to antibiotics ****
what is this |
kawasaki
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if a kid has an acute fever for 5 days what do you think ********
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kawaskai
100.4 F |
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Do you see cardiomegaly in Kawasaki disease
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NO!
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Drug reactions (no fever)
JRA (chronic low grade temp, rash when fever peaks) Measles (rash different, measles has exudative conjunctivitis) can all be confused with? |
Kawaskai
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Second common acquired heart disease in childhood?
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Rheumatic Fever/Heart Disease
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what acquired heart disease has a diastolic murmur
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Rheumatic Fever/Heart Disease
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what leads to rheumatic fever
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Untreated Group A b- hemolytic streptococcus of the pharynx
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if you have a strep infection that is not in the mouth, will it lead to rheumatic fever?
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NO it must be in the pharynx
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what are Jones criteria for?
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rheumatic fever
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Scarlett Fever, elevated ASO, or positive throat culture are all buzz words for what
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rheumatic fever
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Must have evidence of what to diagnose rheumatic fever
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an antecedent strep infection
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What is the most common valve affected in carditis associated with RF?
**KNOW THIS SLIDE |
Mitral Valve - most common
Insufficiency Congestive heart failure Stenosis, occurs years later |
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when does carditis occur?
**KNOW THIS SLIDE |
Occurs 1-2 weeks after strep infection
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what will increase your risk of getting carditis?
**KNOW THIS SLIDE |
having had a prior attack
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where does the arthritis associated with RF normally affect?
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Involves large joints
Knees Elbows Wrists Ankles |
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If you see erythema marginitum what do you have?
**** KNOW |
Seen in rheumatic fever
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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for the diagnosis of Rheumatic fever, what do you need to have (3 options)
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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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What is the treatment for Rheumatic Fever? 4
***KNOW THIS SLIDE |
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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What anti-inflammatory agents do you use with rheumatic fever
***KNOW THIS SLIDE |
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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When do you use prednisone in treatment of rheumatic fever?
***KNOW THIS SLIDE |
Reserved for severe cases of carditis
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to prevent recurrence of rheumatic fever, what do we do?
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give penicillin until age 21-25
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if you have rheumatic heart disease, and are on penecillin for treatment, what do you have to do if you have any type of procedure (teeth cleaning, colonoscopy, etc.)
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must use more drugs (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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Murmur heard best at the apex makes you think
***** |
MR
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arthritis vs arthralgia, which is major/minor jones criteria
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arthrITIS = major; arthrALGIA = minor
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what is the rash seen in rheumatic fever?
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Rash is erythema MARGINATUM,
but arthritis is MIGRATORY Erythema migrans = Lyme disease |
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what are the risk factors for atherosclerosis? 7
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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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risk of obesity increases 40% due to what?
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If one parent is overweight or obese
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What type of dairy products are recommended for children?
****KNOW THIS SLIDE |
including low-fat dairy products for all children over two years of age.
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what is the most important prevention for atherosclerosis of children?
****KNOW THIS SLIDE |
Most importantly, a healthy diet & increased physical activity for all children
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If a child has a family history of high cholesterol/high fat levels or early CV disease, what do you need to do? Starting at what age?
****KNOW THIS SLIDE |
Screening (a fasting lipid profile) - starting at age 2 years and then every 3-5 years
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At what age and LDL level do you need to start thinking about medications?
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8 year old
with LDL greater than 190 |
