Australian Doctor 12th July Issue 2024 | Page 26

26 HOW TO TREAT : IDENTIFYING HEART DISEASE IN CHILDHOOD

26 HOW TO TREAT : IDENTIFYING HEART DISEASE IN CHILDHOOD

12 JULY 2024 ausdoc . com . au
hypertrophic cardiomyopathy ,
which commonly has an autosomal dominant inheritance . Generally , the course of the cardiomyopathy in the affected offspring mirrors the course of the parent .
INFLAMMATORY DISORDERS Rheumatic fever Cardiac involvement in rheumatic fever remains a problem , especially in the
Maen K Househ / CC BY-SA : bit . ly / 4aamV32
Staphylococcus aureus , group A streptococcus or haemophilus influenza type B . 44 A non-virulent organism , such as viridans streptococci , will usually infect a heart with a pre-existing structural abnormality .
In light of the above , it is important that any infant , child or adolescent with a positive blood culture has an echocardiogram before discharge . This will ensure that infective endo-
Indigenous population . The impor-
carditis has not occurred despite the
tance of a definitive diagnosis based
absence of a murmur .
on the modified Jones criteria ( one
Any child with a structural heart
major and two minor or two majors ) is
abnormality who is febrile and war-
essential — together with evidence of a
rants an antibiotic requires a blood
recent group A streptococcal infection
culture before the administration of
and further supported by echocardio-
the antibiotic . Once an antibiotic has
graphic evidence of mitral and / or aortic
been administered , the cultures are
incompetence . 8
often negative . This adds to the dif-
Twice-daily oral penicillin is an
ficultly in confirming a diagnosis of
effective prophylaxis , as is a four-
infective endocarditis , especially if
weekly injection of benzathine pen-
vegetation is not clearly seen on echo-
icillin if compliance is an issue . Such
cardiograph . In such situations , the
prophylaxis is a major undertaking
fever frequently recurs once the anti-
for the child and parent . Five years is
biotics have been stopped .
recommended if the child has no evi-
Antibiotic prophylaxis is no longer
dence of cardiac involvement . Ongoing prophylaxis is recommended until
Figure 7 . Clinical manifestations and time course of Kawasaki disease .
considered mandatory for any procedure carried out in a potentially
the age of 20 , 25 or even older if there
infected field that may lead to a bac-
is cardiac involvement .
plantar erythema , asymmetrical cer-
at three months , then the aspirin may
children appears to be a rare compli-
teraemia in a child with a low-risk
How does one impress on the
vical node enlargement , a non-spe-
be stopped . Later review may still be
cation of COVID-19 infection . Many
structural heart abnormality , such as
parent the need for twice-daily or
cific erythematous rash and arthritis
warranted because of the increased
of the clinical features are similar
a small VSD , mitral valve prolapse or
monthly prophylaxis for so long if one
affecting the large joints ( see figure
risk of ischaemic heart disease arising
to Kawasaki disease . The condition
mild pulmonary valve stenosis .
is unsure of the diagnosis ?
8 ).
from atherosclerosis .
generally affects older patients and
However , antibiotic prophylaxis
A retrospective diagnosis is gen-
The infants and children are often
Lifestyle measures are recom-
seems to occur more frequently in
is essential in any patient with pros-
erally not possible , emphasising the
initially diagnosed with an infection
mended : not being overweight ,
those of African-American and His-
thetic material in the heart , such as a
importance of reaching a diagnosis
and started on antibiotics , delaying the
remaining active and normotensive ,
panic descent . About 70 % of affected
conduit , a prosthetic valve or a pace-
at the time of presentation . This may
infusion of IV gamma globulin . The
abstinence from smoking and ensur-
patients present in incipient cardiac
maker wire , or who is cyanosed .
be difficult as many children present
gamma globulin substantially reduces
ing that the cholesterol and lipid pro-
failure , arising from poor LV function .
Where antibiotic prophylaxis is not
with fever and a migratory arthralgia .
the incidence of coronary artery
files are normal . The persistence of
Many require intensive care initially ,
recommended , there is still the need
Aspirin will rapidly resolve the latter
involvement and the development of
aneurysms requires long-term cardiac
although most recover over the next
for good dental hygiene , as well as
and is best withheld until a clear diag-
aneurysms ( see figure 9 ) and thrombo-
surveillance . Those with so-called
few days . 43
ensuring the skin is as clean as pos-
nosis has been made and the parents
sis from about 25 % to 2-3 %. The earlier
giant aneurysms may develop cor-
sible by vigorously treating acne and
counselled accordingly .
the infusion is started , the better the
onary artery stenosis , angina and
Infective endocarditis
local skin infections . Nevertheless ,
response ; there is an almost immedi-
infarction . Coronary artery interven-
Historically , infective endocarditis
many adolescents with a major car-
Kawasaki disease
ate loss of the irritability , a drop in the
tions by catheter or bypass surgery
was thought to occur in any infant ,
diac abnormality still undergo tattoos
This multisystem inflammatory disorder of uncertain aetiology is more severe in male infants of Asian ori-
fever and an overall improvement in patient wellbeing .
Once this condition is diagnosed ,
may be required . The infant or child may frequently present with only some of
child or adolescent with an underlying structural cardiac abnormality following a bacteraemia or septicaemia ,
and body piercings .
CHOLESTEROL , TRIGLYCERIDES AND
gin . It presents with multiple symp-
children require surveillance over
the features described earlier . This
such as after extraction of an infected
LIPID PROFILE
toms and signs before the telltale
the next few months to exclude the
so-called atypical Kawasaki disease
tooth . Yet often , there is no definite
Increasing attention has been paid to
exfoliation of the tips of the fingers
development of coronary aneu-
adds to the difficulty of reaching a
preceding event that leads to the
the lipid profile of adolescents , espe-
and toes some two weeks after the
rysms , which usually take 2-3 weeks
diagnosis and results in a delay in
seeding . In addition , it is now clearly
cially if there is a family history of
onset of the fever ( see figure 7 ). 9 Bilateral non-purulent conjunctivi-
to occur . In the interim , the patient is maintained on low-dose aspirin .
instituting appropriate treatment .
recognised that infective endocarditis may occur not only in those with
hypercholesterolaemia . The importance of having an ideal weight , ade-
tis is almost uniformly present . Fur-
This antiplatelet effect prevents cor-
Multisystem inflammatory
a structural cardiac abnormality but
quate exercise and abstaining from
ther signs include cracking of the
onary thrombosis , which may cause
syndrome in children
also in children with a normal heart
smoking cannot be overemphasised .
corners of the mouth , red swollen
a myocardial infarction or death . If
Akin to Kawasaki disease , multi-
if the organism causing the bacterae-
However , despite a low cholesterol
lips , a strawberry tongue , palmar and
the echocardiogram remains normal
system inflammatory syndrome in
mia / septicaemia is virulent , such as
and , at times , low-fat diet , readings
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Figure 8 . Kawasaki disease . A . Bilateral non-exudative conjunctival injection with perilimbal sparing . B . Strawberry tongue and bright red lips that are swollen with vertical cracking and bleeding . C . Erythematous rash involving perineum . D . Erythema of the palms , which is often accompanied by painful , brawny oedema of the dorsa of the hands . E . Erythema of the soles and swelling of the dorsa of the feet . F . Desquamation of the fingers . G . Erythema and induration at the site of a previous vaccination with BCG . H . Perianal erythematous desquamation .