Transcript MI in KAWASAKI`S DISEASE

MI in KAWASAKI’S DISEASE
E.J.Lovett, Jr. MD WRAMC
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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E.J.Lovett, Jr. MD WRAMC
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.
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E.J.Lovett, Jr. MD WRAMC
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.
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E.J.Lovett, Jr. MD WRAMC
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%
E.J.Lovett, Jr. MD WRAMC
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.
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E.J.Lovett, Jr. MD WRAMC
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.
E.J.Lovett, Jr. MD WRAMC
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.
E.J.Lovett, Jr. MD WRAMC
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)
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E.J.Lovett, Jr. MD WRAMC
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
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E.J.Lovett, Jr. MD WRAMC
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
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E.J.Lovett, Jr. MD WRAMC
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.
E.J.Lovett, Jr. MD WRAMC
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.
E.J.Lovett, Jr. MD WRAMC
Training Effects

Static exercise leads to increased wall
thickness without increased LV
diameter. There is also no significant
increase in stroke volume.
E.J.Lovett, Jr. MD WRAMC
ATHLETIC HEART
SYNDROME
Clinical Exam:
systolic murmur
bradycardia
audible 3rd and 4th heart sounds
cardiomegaly, globular heart on CXR
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E.J.Lovett, Jr. MD WRAMC
ATHLETIC HEART
SYNDROME

Electrocardiographic rhythm changes
sinus bradycardia
sinus arrhythmia
wandering atrial pacemaker
1st degree heart block
Wenkebach
junctional rhythm
E.J.Lovett, Jr. MD WRAMC
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.
E.J.Lovett, Jr. MD WRAMC
Athletic Heart Syndrome
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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.
E.J.Lovett, Jr. MD WRAMC
Athletic Heart Syndrome
THE PHYSICAL EXAM,ECG, AND ECHO
OF HIGHLY TRAINED ATHLETES MAY
SIMULATE ISCHEMIC HEART DISEASE
OR HYPERTROPHIC CARDIOMYOPATHY.
E.J.Lovett, Jr. MD WRAMC
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
E.J.Lovett, Jr. MD WRAMC