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Week 6 - Cardiology (diseases)
Cardiology
20
Nursing
Graduate
11/09/2014

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Cards

Term
Rheumatic Fever - criteria
Definition
- Jones Criteria
J for joints (arthritis) – migrating polyarthritis
O like shape of the heart (carditis)
N for nodules (subcutaneous nodules)
E for erythema marginatum
S for Sydenham Chorea
Term
Jones Modified Criteria
Definition
A. Two major criteria - OR-
B. One major plus two minor criteria - PLUS -

C. evidence of previous streptococcal infection
so you need C+ (A or B)
Term
Evidence of previous streptococcal infection
Definition
- recent scarlet fever
- raised antistreptolysin O (ASO) titer
- positive throat culture
Term
Jones Major criteria
Definition
- carditis
- arthritis
- chorea
- erythema marginatum
- subcutaneous nodules
Term
Jones Minor criteria
Definition
- previous rheumatic fever
- arthralgia
- fever
- acute phase reactants
- first-degree atrioventricular block
Term
Rheumatic carditis
Definition
- Present in 50% cases of RF
- “Sleeping” tachycardia is an early sign
- Mitral and aortic valves most commonly involved
Term
Rheumatic Arthritis
Definition
- Most common manifestation of RF
- Pain, swelling and erythema
- Resolves within 1 week
Term
Rheumatic fever - tx and prevention
Definition
Benzathine penicillin 1.2 mega units IM
Aspirin 75-100 mg/kg for 6-8 weeks
Steroids for severe carditis
Digoxin (used in heart failure), diuretics
Prevention with Benzathine Penicillin q 4 weeks.
Term
Kawasaki syndrome
Definition
Triphasic
Acute: 7 to 14 days
Subacute: 10 to 25 days
Convalescent: 21 to 60 days

- Unknown cause (New Haven coronavirus)
- winter and spring
- Median: 2.3 yrs, 80% less than 4
- lots of atypical presentation
Term
Kawasaki syndrome - acute phase (8)
Definition
- Fever: sudden onset, spiking as high as 40 degree c (like 104), precedes other sns and sxs by 1 to 2 days, lasts more than 5 days (slide says 5 days)

- Irritability

- Bulbar Conjunctivitis: appears early; nonexudative and nonulcerative, just RED EYES

- Oropharnygeal erythema: red, cracked, fissured lips; “strawberry tongue”, and diffuse mouth erythema

- Rash: scarlitiniform (sand-paper like), morbilliform, macular and papular erythema, multiforme-like with target lesions, urticarial plaques, or pustular. Involvement of the perineum

- Lymphadenopathy

- Distal extremity edema and erythema (leading to desquamation)

- thrombocytosis (sometimes really high) and elevated ESR seen in 2nd week
Term
Kawasaki syndrome - Subacute phase
Definition
Desquamation of fingers and toes
Term
Kawasaki syndrome - complications
Definition
- Cardiac: tachycardia, dysrhythmias, pericarditis, pericardial effusion, myocarditis, mitral or aortic insufficiency, and CHF.

****Coronary artery aneurysms in the 2nd week– MOST COMMON COMPLICATION (KNOW THIS!!!)
Term
Kawasaki syndrome - Tx
Definition
- IVIG 2 gm/kg as a single dose and high dose aspirin
- steroids occasionally needed for cases unresponsive to IVIG (w/ cardiac involvement)
Term
Syncope danger signs
Definition
SYNCOPE w/ exertion or excitement, anger fear startle; cardiac arrest w/ exercise or excitement
Term
Syncope when to refer
Definition
if exercise-induced, associated w/ chest pain, palpitations, or dyspnea, cardiac disease, positive family history, or if history suggests other illness
Term
Benign types of syncope (4)
Definition
vasovagal, orthostatic hypotension, hyperventilation, breath holding spells
Term
Vasovagal
Definition
e.g. secondary to hunger, fear, fatigue, overcrowding, sight of blood)
Term
Cardiovascular
Definition
Sudden onset, or during exercise or while lying down
Term
Noncardiovascular
Definition
– migraine, orthostatic hypotension, hypoglycemia, drugs, hyperventilation or hysteria,
o Danger!! = SYNCOPE w/ exertion or excitement, anger fear startle; cardiac arrest w/ exercise or excitement
Term
QT should always be measured in
Definition
syncope, seizures, congenital deafness, near SIDs
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