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Acquired Cardiac Disease

Acquired Cardiac Disease . Rheumatic Fever Arterial Ischemic Stroke Arrhythmia . Pathophysiology of Rheumatic Fever. Also known as Kawasaki disease (KD) Leading cause of acquired heart disease in children

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Acquired Cardiac Disease

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  1. Acquired Cardiac Disease Rheumatic Fever Arterial Ischemic Stroke Arrhythmia

  2. Pathophysiology of Rheumatic Fever • Also known as Kawasaki disease (KD) • Leading cause of acquired heart disease in children • An acute, febrile, multisystem disease is usually manifested by a self-limited generalized vasculitis of unknown etiology. (Ferri: Ferri's Clinical Advisor 2011)

  3. Risk Factors for Cardiac Disease • Tobacco use • High blood cholesterol • Obesity • Poor physical activity • Diabetes

  4. Demographics of Patient with Rheumatic Fever • Children <5 years old; peak age 18-24 months • Asian descent have highest incidence, followed by African Americans, Puerto Ricans, Mexican Americans and American Indians • Evidence of coronary artery disease

  5. Signs and Symptoms of Rheumatic Fever • Fever (greater than 102.2 F) for more than 5 days and 4 out of the 5 below features: • bilateral, painless bulbar conjuctival injection without exudate • oral mucosal changes: erythema and fissured lips, strawberry tongue • polymorphous exanthema (in truncal region) • extremity changes: acute erythema and edema of hands and feet; membranous desquamation of fingertips • cervical lymphadenopathy <1.5 cm in diameter; unilaterally and anterior

  6. Additional S&S of Rheumatic Fever • Cervical lymphadenopathy • Exanthema and extremity changes • Aneurysms of peripheral arteries (axilla) • Beaus’s lines (transverse grooves of the nails) • Diarrhea • Dyspnea • Arthralgia • Myalgia

  7. Treatment for Rheumatic Fever • Reduce inflammation in systemic and coronary arteries to prevent arterial thrombosis (aspirin) • Prevent myocardial ischemia or infarction • Oxygen therapy • Salt restriction in pts with congestive heart failure • Emollient creams for peeling skin • Angioplasty and coronary bypass graft surgery for chronic conditions

  8. Arterial Ischemic Stroke (AIS)Risk factors • Antiphospholipid antibodies • Increased Lipoprotein • DNA factor V Leiden mutation • Factor II genotype • congenital heart malformation • sickle cell disease and hypoxemia • meningitis • Cardiac procedures such as surgery, biopsy, interventions • Immobilization • Anemia • lipid metabolism disorders • Prothrombotic abnormalities such as anticardiolipin antibody, lupus anticoagulant, deficiencies in protein C and S and antithrombin

  9. Signs and Symptoms of AIS • Fever • Seizures/symptomatic epilepsy • Cognitive impairments • Hemiparesis • Large middle cerebral or cerebellar infarcts

  10. Treatment for AIS • Anti-thromotic therapies • Low molecular weight heparins (first choice) indications include arterial dissectino, coagulation disorders, embolisms from heart, progressive neurologic deficits • Heparin therapy • Aspirin- to reduce reoccurrence • Warfarin- for congenital or acquired heart disease, sever hypercoagulable states, arterial dissection, recurrent AIS while on aspirin • Thrombolytic agents • Neuroprotective agents • Immunosuppressive therapy • Stabilizing systemic factors and managing the causes

  11. Arrhythmia Pathophysiology • IVNC- Isolated Ventricular Non-Compaction • Tachycardia • Abnormal heart rhythms • Can quickly progress to cardiac arrest and brain death

  12. Demographics of Patient with Arrhythmia • Children or adults • Appear healthy • 44.8% are men with an average age of 66.8 years

  13. Signs and symptoms of Arrhythmia • Symptoms are not obvious until disease is advanced • Heart palpitations • Dysarthria • Hemiparesis • Recent onset of nausea, vomiting and malaise • Tachycardia • Reduced systolic function • Anger and hostility common in men

  14. Treatment for Arrhythmias • Anticoagulants decreases risk for a recurrent stroke by 50%

  15. References • Ferri, Fred, M.D., F.A.C.P. (2011). Ferri’s Clinical Advisor, 1st ed. Philadelphia, PA. • Barreirinho, S. MD, et al (2003) Inherited and Acquired Risk Factors and Their Combined Effects in Pediatric Stroke. Pediatric Neurology; 28, 3. • Vatthyam, R. K., Bates, J. R., & Waller, B. F. (2009). Acute cardiac and neurologic decompensation in a high school athlete. J Am Soc Echocardiogr, 22(12), 1420 e1421-1423. doi: 10.1016/j.echo.2009.06.010 • Kumar, A.S et al (1995). Results of Mitral Valve Reconstruction in Children with Rheumatic Heart Disease. The Society of Thoracic Surgeons, 60: 1044-7.

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