Endocarditis, Rhematic Fever, and Kawasaki's (Peds)

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ariabarr1
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145364
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Endocarditis, Rhematic Fever, and Kawasaki's (Peds)
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2012-04-02 21:38:46
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Endocarditis Rhematic Fever Kawasaki Peds
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Endocarditis, Rhematic Fever, and Kawasaki's (Peds)
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  1. Infectious Endocarditis
    • infection of valves and inner lining of the heart
    • most infections are bacterial or fungal
  2. Association w/ endocarditis
    • dental work
    • post cardiac surgery
    • long term indwelling lines
    • catheterizations
    • long-term lines (PICC, port-a-cath, etc)
    • fungal (immunosuppressants; on long-term antibiotics)


    ALL AFFECT VALVES OF THE HEART
  3. Non-specific Symptoms of Endocarditis
    • fever
    • HA
    • anorexia
    • malaise
  4. Dx Tools of Endocarditis
    • EKG (changes in PR intervals)
    • increased erythrocyte sedimentation rate
    • elevated c-protein, elevated WBC
    • blood culture
    • echocardiography
  5. Complications of Endocarditis
    • valave damage (mitral or aortic)
    • embolism
    • CHF
    • depression
  6. Tx of Endocarditis
    • long term antibiotics (4-6 weeks)
    • rest
  7. Rheumatic Fever
    • 5-12 y/o
    • late winter/early spring
    • autoimmune reaction to group A beta hemolytic streptococcal infection
    • usually 4-6 weeks after throat or upper respiratory infection
    • develops 2-6 weeks after streptococcal pharyngitis
  8. Tx of Rheumatic Fever
    • antibiotics (primary and prophylactic)
    • rest
  9. Complications of Rheumatic Fever
    • bacterial endocarditis
    • cardiac valve damage
  10. MAJOR symptoms of Rheumatic Fever
    • carditis
    • polyarthritis (inflammation of several joints)
    • erythema marginatum (redness due to congestion of capillaries)
    • subcutaneous nodules (usually around joints)
    • chorea (jerking motions)
  11. MINOR symptoms of Rheumatic Fever
    • fever
    • arthralgia (joint pain)
    • positive throat culture (testing for strepto)
    • rapid strep antigen test (dx of strep throat)
    • elevated sedimentation rate (how quickly RBC settle)
    • C-reactive protein (protein produced by the liver that elevated in the presence of inflammation)
  12. Kawasaki's Disease a.k.a....
    Mucocutaneous Lymph Node Syndrome
  13. Kawasaki Disease
    • believed to be an autoimmune reaction
    • causes extensive inflammation of small vessels and capillaries
    • unknown cause, but often follows an upper respiratory tract infection
    • 85% of kids <5 y/o
    • more common in males
    • most common cause of acquired heart disease in children
  14. Kawasaki's Phases
    • Acute phase
    • Subacute phase
    • Convalescent phase
  15. Kawasaki's Symptoms: Acute Phase
    • high fever (102F or higher) for more than 5 days
    • strawberry tongue
    • rash (tips of fingers/by fingernails and hands)
    • irritability
    • edema
    • bilateral conjuctivitis (red eyes w/ no drainage)
  16. Kawasaki's Symptoms: Subacute Phase
    • peeling of skin
    • arthritis of large bearing joints
    • risk for coronary aneurysms
  17. Kawasaki's Symptoms: Convalescent Phase
    • remains at risk for aneurysms
    • coronary thrombosis or stenosis
    • abnormal lab values
  18. Dx of Kawasaki
    • symptoms as described in the different phases
    • low hemoglobin and hematocrit
    • increased WBC
    • increased sedimentation rate
    • increased liver enzymes
  19. Tx of Kawasaki
    • high dose IVIG (autoimmue; so hoping to turn it off)
    • aspirin (aneurysm burst prevention)
    • possibly additional anticoagulatory therapy
    • affected vessels are never completely normal again
    • NO steroids (inflammation symptoms so looks like nothing is wrong)
  20. Complications of Kawasaki
    • coronary thrombosis or stenosis
    • embolism

    OFTEN ONLY PICKED UP WITH CARDIAC CATHETERIZATION

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