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MI in KAWASAKI’S DISEASE. Epidemiology of Kawasaki’s. 80% 0f patients are under 5 yrs of age Male/female= 1.5 U.S. attack rate 1/10,000 Attack rate for Asians 6/10,000 Attack rate for African American 1.5/10K 2%die during subacute or conval. stage from acute thrombosis of aneurys. CA’s.

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epidemiology of kawasaki s
Epidemiology of Kawasaki’s
  • 80% 0f patients are under 5 yrs of age
  • Male/female= 1.5
  • U.S. attack rate 1/10,000
  • Attack rate for Asians 6/10,000
  • Attack rate for African American 1.5/10K
  • 2%die during subacute or conval. stage from acute thrombosis of aneurys. CA’s
coronary artery aneurysms
CORONARY ARTERY ANEURYSMS
  • Diffuse dilation of CA’s during the acute phase in 30-50% of patients.
  • Aneurysms persist in 15-20%, reduced to < 5% if gammaglobulin used in the acute phase.
  • Most commonly in LCA>LAD>RCA
  • 50% regress to no observable lesion.
coronary artery aneurysms4
CORONARY ARTERY ANEURYSMS
  • In 25%, aneurysms persist but reduced in size.
  • In 25%, aneurysmy heal to severe stenosis or complete occlusion.
  • Of all pats. with aneurysms, 7-10% have MI.
  • Giant aneurysms(> 8mm) during the acute phase at highest risk for MI.
myocardial infarction
Myocardial Infarction

Onset: 40% within 3 months

73% within first yr.

20% occur more than 2 yrs out

5% greater than 6 yrs

Symptoms:63% had symptomatic MI

54% presented in shock

chest pain:<4yr20%,

>4yr 80%

myocardial infarction6
Myocardial Infarction
  • Activity: Only 14% had MI during play or exercise. 63% during sleep or at rest.
  • Mortality: 22% died during the first MI

Infants<1yr, 43% died

  • Prognosis: 41% asymptomatic. Cardiac symptoms due to MR, decreased LV EF, LV aneurysm,angina. 16% of survivors had second MI, 63% died.
myocardial infarction7
Myocardial Infarction

Distribution of coronary stenotic lesions( >75% narrowing):

  • fatal cases: 80% had 2 or 3 vessel disease.40% involved LCA.
  • survivors: 85% had 1 vessel disease( 50% RCA). None had involvement of left main.
ekg and mi kawasaki s
EKG and MI: KAWASAKI’s
  • Fatal cases: 87% had abn Q waves at presentation, Q waves in in precordial leads in 1/2. Deep Q’s in II,III and AVF in 1/3.
mi in congenital heart disease
MI in Congenital Heart Disease
  • Usually ass. with a pressure overloaded ventricle(AS,PS,TAPVR)
  • Most commonly subendocardial or papillary muscle infarction
  • Infarcts occur in the ventricle with the pressure overload
  • Not ass. with CA anamolies( excluding pulmonary atresia VSD)
mi in chd
MI in CHD
  • Represents a myocardial supply demand imbalance
  • Subendocardium at risk due to pressure

load and nature of blood supply

  • Papillary infarction of either ventricle may be associated with a Q wave and diminishing R wave in lead V3R
mi in chd11
MI in CHD
  • 80% of hearts with TAPVR
  • 90% of hearts with severe PS
  • 100% of hearts with severe AS
  • most hearts had acute and old infarcts
  • incidence of infarcts appeared independent of surgery
the pediatric athlete
THE PEDIATRIC ATHLETE

Exercise and Training:

Exercise - Bodily exertion for the purpose of restoring the the and functions to a healthy state or keeping them healthy

1.Dynamic:changes in muscle length and joint movement with small force.

2.Static: large force with little or no change in muscle length or joint move.

training effects
Training Effects
  • Dynamic training: increased LVED diam., The more conditioned, the greater the increase. May begin as early as one week into training.There is an increase in LV wall thickness. Also resting and exercise stroke vol increase. Kids less than 10 yrs seem to show the increase inLV thickness but not in diameter or stroke vol.
training effects14
Training Effects
  • Static exercise leads to increased wall thickness without increased LV diameter. There is also no significant increase in stroke volume.
athletic heart syndrome
ATHLETIC HEART SYNDROME
  • Clinical Exam:

systolic murmur

bradycardia

audible 3rd and 4th heart sounds

cardiomegaly, globular heart on CXR

athletic heart syndrome16
ATHLETIC HEART SYNDROME
  • Electrocardiographic rhythm changes

sinus bradycardia

sinus arrhythmia

wandering atrial pacemaker

1st degree heart block

Wenkebach

junctional rhythm

athletic heart syndrome17
Athletic Heart Syndrome
  • Electrocardiogram: Changes in Repol.

ST segment elevation in precordial

leads.

ST segment elevation normalizes with

exercise.

Tall T waves ass with ST elevation

Isolated T wave inversion.

athletic heart syndrome18
Athletic Heart Syndrome
  • ECHO:

Increased LV end diastolic dimension

Increased LV wall thickness

IVS thickness may increase out of

proportion to LVPW

IVS/LVFM may be 2/1, this is reversed

with deconditioning.

athletic heart syndrome19
Athletic Heart Syndrome

THE PHYSICAL EXAM,ECG, AND ECHO

OF HIGHLY TRAINED ATHLETES MAY

SIMULATE ISCHEMIC HEART DISEASE

OR HYPERTROPHIC CARDIOMYO-

PATHY.

sudden death
SUDDEN DEATH

A witnessed or unwitnessed natural

death resulting from sudden cardiac

arrest occurring unexpectedly within 6

hours of a previously witnessed usual

normal state of health.

Barry Maron 1980