acquired heart disease is something that happens after 6 months of age
Kawasaki's disease - immune response to gram positive infection (toxic shock) - complication = coronary aneurysms. no specific lab test. Treatment = IV immunoglobin (IgG)
survivors grow up with abnormal coronary arteries (no adenosine response)
Kawashocki - >8yo girls; refractory to IVIG; high incidence of aneurysms
Rheumatic heart disease - comes from previous strep infection. polyarthritis (painful and swollen) antibody protein complexes in myocardium (Aschoff bodies) - mitral valve disease. St. Vitus' dance - inflammation of basal ganglia (Sydenham's Chorea). (St. Vitus is the patron saint of dancers, young people and dogs.)
Pericarditis - lower preload = low stroke volume (diastolic failure). JVD and hepatomegaly. -70-80% of cases idiopathic (probably viral); also post surgery. treat with steroids. pericardiocentesis. preload exaggerated with respiratory cycle and pulsus paradoxus present.
Myocarditis - viral etiology most common = entero (Coxsackie B) or adenovirus
patchy involvement - Echo shows dyskinesis. MRI useful for Dx. Biopsy may not show anything if normal area of heart is sampled. Tx ACE ARB Beta blockers, digoxin (but proarrythmic), milrinone (a PDE 3 inhibitor; positive inotropic, vasodilating, also facilitates ventricle relaxation (positive lusitrope) by enhancing Ca++ ATPase reuptake by sarcoplasmic reticulum.
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