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Cardiac (peds)
Acquired Heart Disease
59
Medical
Undergraduate 2
04/16/2009

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Cards

Term
Examples of Acquired heart disease (6)
Definition
Rheumatic Fever, Congestive Heart Failure, Hypertension, Hyperlipidemia, Endocarditis, Kawasaki Disease
Term
Rheumatic Fever is what kind of condition?
Definition
Diffuse inflammatory condition
Term
Origin of Rheumatic Fever?
Definition
Autoimmune
Term
What is a cause or Rheumatic Fever?
Definition
untreated Strep infection
Term
Manifestations of Rheumatic Fever?
Definition
Arthritis, carditis, chorea, erythema, subcutaneous nodules
Term
RF is a diffuse inflammatory condition most probably of autoimmune origine of the connective tissue, primarily of ....
Definition
the heart, joints, subQ tissues, brain and blood vessels
Term
The most serious complication of RF? What can it result in?
Definition
Rheumatic heart disease**permanent damage to teh cardiac valves most commonly the mitral and aortic valves.
Term
When does RF characteristically manifest?
Definition
2-6 wks after an untreated or partially treated group A beta hemolytic streptococcal infection of the upper respiratory tract.
Term
Does the intial infection of RF/strep produce symptoms of pharyngitis?
Definition
It may or may not
Term
When does the manifestations of RF occur?
Definition
during the acute febrile period (first 1-2 wks of illness)
Term
RF**
tender warm erythematous joints (elbow knees, ankles, wrists)
Definition
arthritis
Term
RF**
inflammation of the endocardium including the valves, myocardium and pericardium, may be subclinical and is usually dx by the development of a cardiac murmer, cardiac enlargement or failure, or a pericardial friction rub
Definition
carditis
Term
What is the most frequent manifestation of carditis?
Definition
Mitral valve involvement
Term
involuntary, purposeless jerky mmovements of the legs, arms and face, with speech impairment caused by CNS involvement
Definition
chorea
Term
red, painless skin lesions that start as flat or slightly raised macules, usually over the trunk. This usually spreads at the margins of the lesion with central clearing
Definition
erythema marginatum
Term
small, nontender lumps attached to the tendon sheaths of joints and on bony prominences. They occur only rarely in RF and are usually associated with...
Definition
SubQ nodules ** severe carditis
Term
most common manifestation of RF?
Definition
arthritis
Term
Most serious manifestation and the major cause of mortality during botht the acute and chronic phases of RF?
Definition
carditis
Term
The major long-term consequence of RF?
Definition
Cardiac valvular disease
Term
criteria that assist in making a dx of RX
Definition
hx of previous RF, arthralgias (joint pain) w/out arthritis, fever, elevated acute phase reactants including C-reactive protein and erythrocyte sed rate and first degree AV block on teh ECG, (Have they had a recent strep infection?)
Term
Major Manifestations of RF? (jones criteria)
Definition
carditis, polyarthritis, chorea, erythema marginatum, subQ nodules.
Term
Minor Manifestations of RF (jones criteria)
Definition
Fever, Arthralgia, Elevated erythrocyte sed rate or positive C-reactive protein, prolonged p-r interval, supporting evidence of preceding strep infection: hx of recent scarlet fever, positive throat culture for group A strep
Term
Management of RF?
Definition
eradication of the strep bacteria and tx of other symptoms (joint inflammation, CHF, chroea)
Term
Drug of choice for RF?
Definition
Penicillin
Term
Once dx is established, what is administered in presence of significant carditis to speed resolution of the inflammatory process?
Definition
anti-inflammatory agents (aspirin or corticosteroids)
Term
Children who have had RF (and valve dmage) require what to prevent recurrence?
Definition
secondary phrophylaxis
Term
The child w/out cardiac complications should receive what? for how long?
Definition
antibiotic prohylaxis for 5 years or through age 21-25 yrs- which ever is longer.
Term
Children with rheumatic heart diseas should continue prophylaxis for how long?
Definition
at least 10 years and at least until age 40
Term
also called mucocutaneous lymph node syndrome
Definition
kawasaki disease
Term
is an acute febrile exanthematous illness of children wtih a generalized vasculitis of unknown etiology.
Definition
Kawasaki
Term
Kawasaki disease is a major cause of what in children in the US?
Definition
acquired heart disease
Term
Research suggests that KD is an ________ triggered by ____________
Definition
immune mediated vasculitis/an acute infection or by a bacterial toxin
Term
KD is seen most frequently in what age children?
Definition
younger than 5yrs
Term
KD has a peak incidence in US in what age children?
Definition
18-24 months
Term
KD has 3 phases.. Name them
Definition
1. acute phase 2. subacute phase 3.Convalescent phase
Term
Acute phase of KD lasts how many days?
Definition
10-14
Term
Acute phase of KD is characterized by?
Definition
a high fever that persists longer than 5 days (they need to see a dr.)
Term
T or F: Fever during acute phase of KD should be treated with antibiotic tx?
Definition
F: Unresponsive to antibiotic tx
Term
Clincal signs of KD
Definition
bilateral, nonpurulent conjunctivitis; changes in the mucous membranes (erythema, fissures and cracking of the lips; strawberry tongue); changes in the peripheral extremities such as swelling and erythema of palms and soles; generalized erythematous rash and enlarged cerivical lymph nodes; tachycardia and extreem irritability
Term
The subacute phase of KD lasts how long?
Definition
approx day 15-25
Term
What happens during the subacute phase of KD?
Definition
The fever disappears and most s/s resolve
Term
What is the subacute phase of KD characterized by?
Definition
continued irritability, anorexia, desquamation of the fingers and toes, arthritis and arthralgia and cardiovascular manifestations including CHF, dysrhythmias and the typpical coronary anerysms.
Term
When does coronary aneurysm formation begin in KD?
Definition
early in the 2nd phase
Term
How will coronary artery involvement be detected in KD?
Definition
bsaeline echocardiogram at dx w/ repeat studies during week 3 of the illness and again 1 month later
Term
When does the final stage of KD begin?
Definition
day 26 and lasts until the erythrocyte sed rate returns to normal and all signs of illness have disappeared.
Term
What is common physical manifestation of KD in convalescent stage
Definition
deep transverse grooves called Beau's lines in child's nails.
Term
Dx of KD?
Definition
Fever of 5 days duration in conjunction with at least 4 of the 5 primary clinical finding for acute phase.
Term
In KD the WBC count along with sed rate and C-reactive protein are levated during which phase?
Definition
acute
Term
ECG in acute phase of KD may demonstrate what?
Definition
2st degree heart block
Term
Platelets in KD are detected with what?
Definition
echocardiography
Term
Therapeutic management is directed toward what in KD?
Definition
preventing or reducing the coronary artery damage from KD
Term
What med would first be given for client with KD?
Definition
High dose IV immune globulin in combo with aspirin w/10 days of fever onset (lower the prevalence of coronary artery abnormalities)
Term
At DX of KD what is given?
Definition
IVIG is given in a dosage of 2g/kg over a 10-12hr infusion w/ high dose asa therapy beginning
Term
Initially dosage of the asa is what in KD?
Definition
in the antiinflammatory range of 80-100mg/kg/day in 4 evenly divided doses until fever resolves.
Term
Once fever is gone in KD what is given?
Definition
dosage is reduced to an antiplatelet aggregation dose of 3-5mg/kg/day once daily and continued thr weeks 6-8 of the illness.
Term
If coronary artery abnormalities are identified what will be done (KD)?
Definition
dosage of 3-5mg/kg/day once daily indefinitely
Term
What happens if child is unresponsive to KD therapy?
Definition
Coticosteroids may be considereed
Term
What is the most important aspect of therapeutic management of KD? Why?
Definition
Strep prophylaxis- b/c damaged valves can become further damaged with repeated infections. Prophylaxis is lifeong if there is actual involvement.
Term
Go back over slide 18-30
Definition
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