Порок сердца приобретенный: Приобретённые пороки сердца — причины, симптомы, диагностика и лечение

классификация, диагностика, лечение и профилактика

Пороки сердца — группа заболеваний, характеризующихся нарушением анатомического строения сердечных клапанов или перегородок. Проявляются обычно нарушением гемодинамики.

Данные заболевания встречаются как у взрослых, так и у детей и могут быть связаны с рядом факторов. Чтобы понять, что такое порок, нужно знать не только причины возникновения данного заболевания, но и то, как оно влияет на общее функционирование организма.

Классификация

Строение сердца

Чтобы разобраться в том, какие бывают пороки сердца, необходимо знать их классификацию. Для начала следует сказать, что имеются врожденные и приобретенные пороки.

В зависимости от локализации поражения, бывают следующие виды пороков:

• Патологии клапанов.
• Патологии перегородок.

Согласно количеству пораженных структур, выделяют следующие виды пороков сердца:

• Простые. Поражение одного клапана.
• Сложные. Поражение нескольких клапанов.
• Комбинированные. Сочетание недостаточности и стеноза в одном клапане.

Классификация пороков сердца также учитывает уровень общей гипоксии организма. В зависимости от этого фактора, выделяют следующие виды:

• Белые. Достаточное снабжение тканей и органов кислородом. Цианоз не формируется.
• Синие. Раннее проявление гипоксии, формирование центрального цианоза.

Также для правильной классификации врожденных форм используется таблица по Мардеру:

ИЗМЕНЕНИЕ ГЕМОДИНАМИКИ	БЕЛЫЕ	СИНИЕ
Не нарушена	Правостороннее сердце, неправильное расположение аорты, незначительный дефект межжелудочковой перегородки (ДМЖП)	—
Перенаполнение малого круга	ДМЖП, дефект межпредсердной перегородки, открытый артериальный проток, аномальный дренаж легочных вен	Транспозиция основных сосудов, недоразвитие желудочков, общий артериальный ствол
Обеднение малого круга	Стеноз легочной артерии	Тетрада Фалло, ложный общий артериальный ствол, заболевание Эбштейна
Нарушение кровотока в большом круге	Стеноз устья и коарктация аорты	—

Причины возникновения

Этиология врожденных форм представлена различными хромосомными нарушениями. Также определенную роль играют экологические факторы. В том случае, если мама во время беременности болела краснухой, у ребенка выявляется следующая тройка синдромов:

1. Катаракта.
2. Глухота.
3. Врожденные аномалии сердца. Чаще всего это может быть тетрада Фалло (комбинированный врожденный порок, в состав которого входят стеноз выходного тракта правого желудочка, дефект межжелудочковой перегородки, смещение аорты, гипертрофия правого желудочка).
4. Помимо краснухи, влияние на эмбриональное развитие сердечно-сосудистой системы оказывают следующие инфекционные агенты:

• Вирус простого герпеса.
• Аденовирус.
• Цитомегаловирус.
• Микоплазма.
• Токсоплазма.
• Бледная трепонема.
• Листерия.

Этиология врожденных пороков достаточно широка. К ней можно отнести употребление беременной женщиной алкоголя и наркотических средств. Доказано тератогенное влияние на плод амфетаминов.

Несмотря на то что по наследству пороки не передаются, наличие в семейном анамнезе сердечно-сосудистых патологий повышает риск возникновения клапанных пороков сердца у детей. Также некоторые специалисты говорят о возможном развитии врожденного порока у следующих поколений при близкородственном браке.

Причиной приобретенных пороков развития сердца чаще всего является острая ревматическая лихорадка. Помимо этого, этиология включает следующие заболевания:

• Атеросклероз.
• Сифилис.
• Аутоиммунные заболевания.
• Травмы сердца.

Основные проявления

Патофизиология врожденных пороков сердца в большей степени заключается в нарушении нормального кровообращения. Чаще всего этому способствует:

1. Повышение сопротивления току крови, приводящее к гипертрофии соответствующего сердечного отдела.
2. Создание порочного сообщения между обоими кругами кровообращения.

Очень часто оба этих патогенетических механизма могут комбинироваться. В связи с этим можно выделить следующие признаки пороков сердца:

• Одышка.
• Патологические шумы.
• Обморочные состояния.
• Цианоз.
• Сердцебиение.
• Нарушение ритма.
• Периферические отеки на ногах.
• Асцит (скопление жидкости в брюшной полости).
• Гидроторакс (скопление жидкости в плевральной полости).

Стоит заметить, что компенсированные пороки чаще всего протекают бессимптомно и выявляются при проведении профилактического осмотра. Основные симптомы пороков сердца проявляются тогда, когда организм уже не может своими силами справляться с нарушениями гемодинамики.

Диагностика

На основании одних лишь симптомов, выявленных при проведении осмотра, постановка диагноза «порок сердца» невозможна. Для этого врачу необходимо проведение ряда физикальных и инструментальных методов. Непосредственно при первом посещении специалиста играет большую роль пропедевтика внутренних болезней, в частности, аускультация и пальпаторное обследование.

Чтобы понимать, как определить порок сердца, важно знать основные инструментальные методы, применяемые в диагностике подобных заболеваний. Применяются следующие исследования:

1. Электрокардиография. Электрокардиограмма поможет выявить изменения в работе сердца. ЭКГ при пороках сердца не играет большой роли и чаще всего помогает выявить последствия заболевания.
2. Эхокардиография. Это ультразвуковая диагностика, предназначенная для тщательного изучения функциональных и морфологических особенностей сердца.
3. Фонокардиография – методика, позволяющая отобразить тоны сердца в графическом виде.
4. Рентген. Позволяет выявить конфигурацию сердца, а также обнаружить транспозицию сосудов.

Современная педиатрия особое место в определении врожденных аномалий отводит пренатальному выявлению. Такая диагностика пороков сердца проводится в несколько этапов. Первоначальный этап лежит на плечах обычного гинеколога, а после подозрения на наличие изменений беременная женщина направляется к специалисту по фетальной эхокардиографии.

Лечебные мероприятия

Основной метод терапии большинства сердечных пороков — хирургический. Тем не менее с целью снижения интенсивности прогрессирования заболевания, а также нормализации кровообращения, применяются следующие группы препаратов:

1. Антикоагулянты. Их применение объясняется необходимостью в снижении риска тромбообразования.
2. Мочегонные средства. Диуретики нужны для снятия отечного синдрома, а также компенсирования сердечной недостаточности.
3. β-блокаторы. Необходимы для снижения нагрузки на сердце и нормализации давления.
4. Ингибиторы АПФ. Как и предыдущие препараты, нужны для борьбы с артериальной гипертензией.
5. Антиаритмические средства. Применяются при пороках, во время которых отмечается нарушение ритма сердца.
6. Вазодилататоры. Снижают нагрузку на сердце.

О том, как лечить порок сердца в каждом конкретном случае, сможет ответить только врач, предварительно проведя диагностику. Крайне важно соблюдать все врачебные рекомендации и употреблять препараты строго в указанной дозировке.

Методы хирургического лечения порока сердца у взрослого человека и у детей достаточно разнообразны. Лечение применяется как при приобретенных, так и при врожденных пороках. Показания к проведению оперативного вмешательства напрямую зависят от степени нарушения гемодинамики. При врожденных формах и при наличии препятствия току крови проводятся следующие вмешательства для его устранения:

• Рассечение клапанного сужения в легочном стволе.
• Иссечение суженных участков в аорте.

В том случае, если порок сопровождается переполнением малого круга, необходимо ликвидировать патологический сброс крови. Это достигается за счет проведения следующих мероприятий:

• Перевязка открытого аортального протока.
• Ушивание имеющегося дефекта межпредсердной или межжелудочковой перегородки.

Помимо вышесказанного, при врожденных формах применяются следующие операции пороков сердца:

1. Пластика клапана.
2. Протезирование.
3. Реконструкция.

Реконструкция применяется при сложных патологиях, которые сопровождаются не только нарушением клапанного аппарата, но и неправильным расположением крупных сосудов.

Длительное время считалось, что оперативное лечение врожденных пороков сердца должно проводиться в пятилетнем возрасте или даже позже. Однако уровень медицины в настоящее время позволяет производить хирургическую коррекцию в первые годы жизни.

При приобретенных патологиях клапанного аппарата основным оперативным вмешательством является протезирование. Больному на место поврежденного клапана устанавливается искусственный.

При приобретенных стенозах с целью устранения имеющегося препятствия проводится пластика клапана.

Осложнения

Чтобы понимать, чем опасен порок сердца, нужно знать, какие последствия могут проявиться. Основные осложнения связаны с формированием недостаточности кровообращения. Выделяют следующие её виды:

1. Левожелудочковая недостаточность.
2. Правожелудочковая недостаточность.

Одним из основных признаков тяжелой левожелудочковой недостаточности является одышка, сопровождающаяся выделением пенистой мокроты кровавого оттенка. Ее цвет объясняется наличием особых клеток. Клетки сердечных пороков представлены альвеолярными макрофагами, содержащими гемосидерин. Наличие данных клеток наблюдается при инфаркте легкого или же застое в малом круге кровообращения. И именно из-за них мокрота при данных патологиях обладает “ржавым” цветом.

Сестринский процесс

Сестринский процесс при пороках сердца играет большую роль в повышении качества жизни пациента. Данный процесс преследует следующие цели:

1. Повышение качества жизни больного до приемлемого уровня.
2. Минимизация возникающих проблем.
3. Помощь самому больному и его родным в адаптации к заболеванию.
4. Поддержка основных потребностей пациента или их полное восстановление.

При сердечных пороках данный процесс проводится в несколько этапов. На первом этапе медицинская сестра должна определить основные потребности больного. Второй этап заключается в постановке сестринского диагноза и выявлении основных проблем больного, среди которых нужно выделить следующие:

• Физиологические. В эту группу входят все осложнения основного диагноза.
• Психологические. Тревога относительно изменения качества жизни, а также страх ухудшения прогноза заболевания. Также сюда относится недостаток знаний и умений по общему уходу за здоровьем.
• Проблемы безопасности. Внимание следует уделить повышенному риску инфицирования, неправильному применению назначенных лекарственных средств, а также риску падений при возникновении обморочного состояния.

Третий этап заключается в определении целей, которые должна поставить перед собой медицинская сестра, чтобы облегчить общее состояние больного. В четвертый этап входит реализация всех сестринских вмешательств, которые необходимо провести согласно протоколу лечения и диагностики порока. Последний этап — оценка того, насколько эффективно был проведен сестринский уход, проводится не только медицинской сестрой, но и ее непосредственным начальством, а также самим больным.

Профилактические мероприятия

Профилактика пороков сердца — крайне важный комплекс мероприятий, позволяющий снизить риск возникновения нарушений в работе клапанного аппарата сердца. Стоит отметить, что с целью профилактики врожденных пороков будущей маме нужно соблюдать следующие рекомендации:

1. Своевременная постановка на учет.
2. Регулярное посещение гинеколога в установленные сроки для профилактического осмотра.
3. Правильное питание.
4. Исключение вредных привычек.
5. Коррекция сопутствующих заболеваний.
6. При отсутствии прививки от вируса краснухи, произвести вакцинацию приблизительно за 6 месяцев до планируемого зачатия.
7. Профилактический прием фолиевой кислоты.

Главной причиной приобретенных пороков сердца является ревматизм. Именно поэтому одним из основных профилактических мероприятий является предотвращение развития острой ревматической лихорадки.

Также рекомендуется следующее:

• Ведение здорового образа жизни.
• Правильное питание.
• Своевременное лечение обострений хронических патологий.
• Санация инфекционных очагов.

После лечения взрослых и подростков от ревматизма рекомендуется проведение бициллинопрофилактики.

Также для того, чтобы снизить проявления ревматического процесса, а также предупредить возможные последствия рекомендуется проводить массаж при пороках сердца. Выделяют следующие показания для массажа:

• Неактивная стадия заболевания.
• Период снижения основных проявлений.
• Сформировавшаяся недостаточность кровообращения.

В период активных воспалительных изменений в сердечных оболочках применение массажа не допускается.

90000 cardiovascular disease | Symptoms, Causes, Treatment, & Prevention 90001 90002 90003 Cardiovascular disease 90004, any of the diseases, whether congenital or acquired, of the heart and blood vessels. Among the most important are atherosclerosis, rheumatic heart disease, and vascular inflammation. Cardiovascular diseases are a major cause of health problems and death. 90005 90003 coronary artery; fibrolipid plaque 90004 This micrograph shows a cross section of a coronary artery narrowed by an atherosclerotic plaque (purplish matter inside the artery).The extensive buildup of plaque impedes the flow of blood through the artery and to the heart’s tissues. 90008 National Heart, Lung, and Blood Institute (NHLBI) 90009 90002 Britannica Quiz 90005 90002 Medical Terms and Pioneers Quiz 90005 90002 What determines the blood group in a person? 90005 90002 Life depends on the functioning of the heart; thus, the heart is involved in all death, but this does not account for its prominence in causing death.To some degree, as medical science advances, more people are saved from other illnesses only to die from one of the unsolved and uncontrolled disorders of the cardiovascular system. Some forms of cardiovascular diseases are becoming less frequent causes of death, and continued research and preventive measures may provide even greater benefits. However, changes in lifestyle and diet, including the adoption of more sedentary lifestyles and the consumption of fried foods and foods high in sugar, have resulted in increases in the incidence of otherwise preventable cardiovascular-related illness and death.90005 90002 Heart disease as such was not recognized in non-technological cultures, but the beating heart and its relationship to death have always been appreciated. Sudden death, now usually attributed to heart disease, was recognized as early as the 5th century bce by the Greek physician Hippocrates and was noted to be more common in the obese. The role of disease in affecting the heart itself did not become apparent until the 17th century, when examination of the body after death became acceptable.90005 90002 Gradually, the involvement of the heart valves, the blood vessels, and the heart muscle was observed and categorized in an orderly fashion. The circulation of the blood through the heart was described in тисячі шістсот двадцять вісім by the British physician William Harvey. The recognition of the manifestations of heart failure came later, as did the ability to diagnose heart ailments by physical examination through the techniques of percussion (thumping), auscultation (listening) with the stethoscope, and other means.It was not until early in the 20th century that the determination of arterial blood pressure and the use of X-rays for diagnosis became widespread. 90005 90003 Harvey, William: theory of the circulation of blood 90004 Woodcut depicting William Harvey’s theory of the circulation of blood, from his 90024 Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus 90025 (1628). 90008 National Library of Medicine, Bethesda, Maryland 90009 Get exclusive access to content from our тисяча сімсот шістьдесят вісім First Edition with your subscription.Subscribe today 90002 In 1912 James Bryan Herrick, a Chicago physician, first described what he called coronary thrombosis (he was describing symptoms actually caused by myocardial infarction). Angina pectoris had been recorded centuries earlier. Cardiovascular surgery in the modern sense began in the 1930s, and open-heart surgery began in the 1950s. 90005 90002 The exact incidence of heart disease in the world population is difficult to ascertain, because complete and adequate public health figures for either prevalence or related deaths are not available.Nonetheless, in the 21st century, in many parts of the world, cardiovascular disease was recognized as a leading cause of death. In the more technologically developed countries of the world-such as the United Kingdom and most continental European countries-arteriosclerotic heart disease (heart disease resulting from thickening and hardening of the artery walls) was one of the most common forms of cardiovascular disease. In the early 21st century in the United States, an estimated one-half of the adult population was affected by some form of cardiovascular disease; while heart disease and stroke accounted for a significant proportion of this disease burden, high blood pressure was the most common condition.In other areas of the world, such as the countries of Central Africa, other forms of heart disease, often nutritional in nature, were a common cause of death. In Asia and the islands of the Pacific, hypertensive cardiovascular disease, disease involving high blood pressure, constituted a major health hazard. 90005 James V. WarrenThe Editors of Encyclopaedia Britannica 90002 The heart’s complicated evolution during embryological development presents the opportunity for many different types of congenital defects to occur.Congenital heart disease is one of the important types of diseases affecting the cardiovascular system, with an incidence of about 8 per 1,000 live births. In most patients the causes appear to fit in the middle of a continuum from primarily genetic to primarily environmental. 90005 90002 Of the few cases that have a genetic nature, the defect may be the result of a single mutant gene, while in other cases it may be associated with a chromosomal abnormality, the most common of which is Down syndrome, in which about 50 percent of afflicted children have a congenital cardiac abnormality.In the even smaller number of cases of an obvious environmental cause, a variety of specific factors are evident. The occurrence of rubella (German measles) in a woman during the first three months of pregnancy is caused by a virus and is associated in the child with patent ductus arteriosus (nonclosure of the opening between the aorta and the pulmonary artery). Other viruses may be responsible for specific heart lesions, and a number of drugs, including antiepileptic agents, are associated with an increased incidence of congenital heart disease.90005 90002 In most cases, congenital heart disease is probably caused by a variety of factors, and any genetic factor is usually unmasked only if it occurs together with the appropriate environmental hazard. The risk of a sibling of a child with congenital heart disease being similarly affected is between 2 and 4 percent. The precise recurrence can vary for individual congenital cardiovascular lesions. 90005 90002 Prenatal diagnosis of congenital cardiovascular abnormalities is still at an early stage.The most promising technique is ultrasonography, used for many years to examine the fetus in utero. The increasing sophistication of equipment has made it possible to examine the heart and the great vessels from 16 to 18 weeks of gestation onward and to determine whether defects are present. Amniocentesis (removal and examination of a small quantity of fluid from around the developing fetus) provides a method by which the fetal chromosomes can be examined for chromosomal abnormalities associated with congenital heart disease.In many children and adults the presence of congenital heart disease is detected for the first time when a cardiac murmur is heard. A congenital cardiovascular lesion is rarely signaled by a disturbance of the heart rate or the heart rhythm. 90005 90002 Congenital cardiac disturbances are varied and may involve almost all components of the heart and great arteries. Some may cause death at the time of birth, others may not have an effect until early adulthood, and some may be associated with an essentially normal life span.Nonetheless, about 40 percent of all untreated infants born with congenital heart disease die before the end of their first year. 90005 90002 Congenital heart defects can be classified into cyanotic and noncyanotic varieties. 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Cardiol Rev 13: 274-284, 2005 90006 90007 90004 90007 90004 90007 90016 90003 90004 90005 105 90006 90007 90004 90005 Perry KG, Morrison JC, Rust OA et al: Incidence of adverse cardiopulmonary effects with low-dose continuous terbutaline infusion.Am J Obstet Gynecol 173: 1273-1277, 1995 90006 90007 90004 90007 90004 90007 90016 91475.90000 Acquired heart disease and Kawasaki disease 90001 90002 Acquired heart defects can develop for various reasons, but the main one is Kawasaki disease. This is a vascular disease, which is mainly defined in children, and at an early age. In the absence of timely treatment can lead to serious complications, such as coronary artery aneurysm and more. 90003 90002 Kawasaki disease (CD) is an acute febrile illness of early childhood, characterized by inflammation of medium-sized arteries.Most often, coronary vessels are affected, which increases the likelihood of coronary artery aneurysms and, consequently, sudden death. Such complications develop in approximately 25% of untreated cases; Appropriate medical effects reduce this risk by up to 3-5%. 90003 90002 90007 Kawasaki disease is a major cause of acquired heart defects in developed countries. 90008 90007 [1 — Newburger JW; 90008 90007 Sleeper LA; 90008 90007 McCrindle BW; 90008 90007 Minich LL; 90008 90007 Gersony W; 90008 90007 Vetter VL; 90008 90007 Atz AM; 90008 90007 Li JS; 90008 90007 Takahashi M; 90008 90007 Baker AL; 90008 90007 Colan SD; 90008 90007 Mitchell PD; 90008 90007 Klein GL; 90008 90007 Sundel RP.90008 90007 Randomized trial of pulsed corticosteroid therapy for the primary treatment of Kawasaki disease. 90008 90007 N Engl J Med. 90008 90007 2007; 90008 90007 356 (7): 663-75] 90008 90003 90002 It is worth pointing out that the incidence of CD in the continental US is about 25 per 100,000 children under the age of 5 years, while in Japan the incidence is estimated at about 250 per 100,000 children under the age of 5 years. The pathological condition is more often defined in children under 5 years old, with the majority of patients under 2 years old.However, Kawasaki disease can also affect older children. It is more common among boys, mostly developing in the winter and spring months. 90003 90002 90049 Video: What is valvular heart disease? | Circulatory System and Disease | NCLEX-RN | Khan Academy 90050 90003 90002 90053 90054 90003 90056 Impact of Kawasaki disease on the heart 90057 90002 BK is most often regarded as generalized vasculitis, which affects medium-sized arteries. Although vascular inflammation is most pronounced in the coronary vessels, veins, capillaries, small arterioles and large arteries can also become inflamed with the development of an appropriate clinic.90003 90002 90007 Kawasaki disease can affect the heart, causing the following complications: 90008 90003 90064 90065 Aneurysms of the coronary arteries (or swelling of the arteries). 90066 90065 Valve insufficiency (most often mitral valve regurgitation). 90066 90065 The accumulation of fluid around the heart (effusion pericarditis). 90066 90071 90002 Kawasaki disease is a major cause of acquired heart defects in children. As many as 25% of children with Kawasaki disease, the heart is affected, especially if not properly treated.Aneurysms of the coronary arteries, blood vessels that supply oxygen to the heart muscle, are the most important complication of Kawasaki disease. With the passage of the necessary treatment, the risk of coronary artery disease is reduced by about 5%. 90003 90002 90007 In general, if changes in the coronary vessels did not develop within six to eight weeks after the onset of the disease, the risk of these changes is very low. 90008 90003 90002 If a coronary aneurysm has occurred, the presence of long-term changes in the heart vessel depends on the size of the aneurysm — changes in the coronary artery can pass, remain unchanged or progress.Patients with large aneurysms are at risk of developing coronary artery clots or stenosis (narrowing) as the aneurysms heal. 90003 90002 Inflammation of the heart valve or heart muscle, often observed in the acute phase of the development of CD, can lead to such acquired heart defects as 90007 90049 mitral or tricuspid valve insufficiency 90050 90008. Such pathological disorders can develop independently of coronary artery disease. Valvular apparatus dysfunction most often disappears when the underlying disease is eliminated, but the preservation and progression of a valve defect is sometimes observed.There is also late aortic or mitral insufficiency caused by thickening or deformation of the fibrous valves, with time intervals from several months to several years after the onset of Kawasaki disease. Some of these lesions require valve replacement. 90003 90002 90007 It should be pointed out that acquired heart defects, unlike congenital ones, occur during a person’s life and can develop at any age, in particular with CD — in early childhood from 2 to 5 years. 90008 90003 90002 It was reported that in half of the patients with small coronary aneurysms and acquired heart defects, the changes disappear during the first year after the disease.Unfortunately, doctors can not give a reliable prediction of how exactly the disease will develop in a particular patient. 90003 90002 Regardless of the degree of damage to the coronary arteries and the valvular apparatus, the child will need to visit a pediatric cardiologist, both during the childhood and adulthood. 90003 90002 90095 90095 90003 90056 The reasons 90057 90002 The etiology of Kawasaki disease remains unknown. For a long time there was an assumption that the etiology of CD is infectious, that is, it is transmitted from one person to another.However, the involvement of a single infectious agent has not been proven. Also, autoimmune reactions and genetic predisposition have been proposed as possible etiological factors for CD. 90003 90002 90049 90007 Infection 90008 90050 90003 90002 The characteristics of CD that are of concern for infectious etiology include the appearance of epidemics, mainly in the late winter and spring, with three-year intervals, and the wave-like geographical distribution of these epidemics. BK is rare in children younger than 4 months, which suggests that maternal antibodies can provide passive immunity.90003 90002 90007 Epidemiological data claim, however, that the transmission of the disease from person to person is unlikely. 90008 90003 90002 Some authors have suggested a controversial relationship with CD with recent carpet washing, the use of a humidifier in a child’s room, a recent respiratory illness, and places near water bodies. These data led to a hypothesis related to water. 90003 90002 Over the years of studying the disease, numerous infectious agents have been involved; however, to date, no pathogen has been detected as the main cause.90003 90002 90049 90007 Genetic factors 90008 90050 90003 90002 Genetic susceptibility to BC has long been suspected. Brothers and sisters of affected children are 10-20 times more likely to develop CD than the general population. It is also noted that children in Japan whose parents are ill with CD have a more severe form of the disease and are more susceptible to relapses. This risk is highest in twins, for whom this figure is approximately 13%. 90003 90002 By 2014 року, 6 genetic loci were associated with BC, which was confirmed by general genomic studies.However, the etiology of CD remains quite complex, so these genetic factors are still only partially used for the diagnosis and treatment of the disease. 90003 90002 90049 Video: What is Kawasaki disease? | Circulatory System and Disease | NCLEX-RN | Khan Academy 90050 90003 90002 90133 90054 90003 90056 Diagnostics 90057 90002 There is no one specific test for determining Kawasaki disease. The doctor makes a diagnosis based on the signs and symptoms identified in the child. Laboratory tests can help with the definition of inflammation, blood rheology and other indicators.90049 90007 Prolonged fever 90008 90050 (that is, more than five days and, as a rule, more than 38.5 centigrade) is often the first symptom that warns the doctor about the need to consider Kawasaki disease. 90003 90002 90007 The main manifestations that help diagnose are as follows: 90008 90003 90064 90065 Prolonged high temperature. 90066 90065 A nonspecific red rash that often affects the groin area and can peel off. 90066 90065 Red eyes or conjunctivitis. 90066 90065 Very red lips and tongue.90066 90065 Enlarged lymph nodes on one side of the neck. 90066 90065 Swollen, red hands and feet, which sometimes flaky skin. 90066 90065 Soreness in the joints. 90066 90065 Irritability and moodiness in children. 90066 90071 90002 90167 90167 90003 90002 90007 In some children, the gallbladder increases, and then there may be abdominal pain, sometimes accompanied by vomiting. 90008 90003 90002 Other diseases and common viral infections may have the same symptoms. To determine if a child has Kawasaki disease, a doctor may order blood tests to identify: 90003 90064 90065 A recent streptococcal or viral infection.90066 90065 The body’s immune response. 90066 90071 90002 Additionally, a urine test can be performed. 90003 90002 These laboratory tests are quite informative, but the only way to diagnose Kawasaki disease is to have appropriate clinical criteria for most of the signs and symptoms listed above. 90003 90002 If the child determines the criteria for diagnosing Kawasaki disease, consult a cardiologist. The doctor of this specialty specifies the history of the disease and conducts a physical examination of the patient.Additionally, the patient is assigned 90007 90049 electrocardiography 90050 90008 (to assess the electrical conductivity of the heart) and 90049 90007 echocardiography 90008 90050 (ultrasound of the heart to determine the operation of the valve apparatus). Even if these tests are normal, the child is most often given treatment based on clinical symptoms and laboratory tests. 90003 90056 Kawasaki disease treatment 90057 90002 Treatment is usually carried out in a hospital setting and may take two to five days.90003 90002 Therapy for BC involves the use of 90049 90007 intravenous gamma globulin 90008 90050 (IVHG), which is an infusion of intravenous infusion together with high-dose aspirin approximately every six hours. The medicine helps reduce swelling and inflammation in the blood vessels. IVHG can also reduce, but NOT eliminate, the risk of developing coronary aneurysms. 90003 90002 The drug is most effective during the first 10 days from the onset of the disease. The risk of developing coronary changes is reduced from 25% to less than 5% if the drug is used in the first 10 days of illness.90003 90002 90007 Minor acquired heart defects in CD can be eliminated independently in the case of effective treatment of the underlying disease. 90008 90007 In rare cases, specific treatment is required in the form of surgery. 90008 90003 90002 After discharge, the child will have to continue to take high doses of aspirin until the signs of inflammation and fever disappear. 90003 90064 90065 Children continue to take low-dose aspirin every day for six to eight weeks or more. 90066 90065 The child will continue to undergo periodic check-ups with a cardiologist after Kawasaki disease resolves.90066 90071 90002 Parents are often concerned about the use of aspirin in children due to the occurrence of Reye’s syndrome in the background of the use of this drug. 90003 90002 90007 Reye’s syndrome is an inflammatory process that affects the liver and brain, with it occurring more often in patients who use aspirin for a long time and have chicken pox or flu. 90008 90003 90002 Some doctors suggest that if a child takes aspirin for a long period of time for any reason, he should be vaccinated against the flu to avoid developing the disease.90003 90002 It is important to know that if a child is ill with chicken pox while taking aspirin, or someone from his family has chicken pox, then you should immediately contact your doctor for advice on further action. 90003 90002 90233 90233 90003 90002 90007 90049 Cardiac monitoring 90050 90008 90003 90002 The patient will continue to be monitored by a cardiologist after discharge. The first visits to the doctor, as a rule, pass in two weeks and six — eight weeks after discharge.If necessary, an echocardiogram and an electrocardiogram will be repeated, which will allow to check the condition of the valves and the coronary arteries in a child. If by six to eight weeks there are no signs of heart damage, then the patient’s risk of heart disease is extremely low. 90003 90002 In the absence of damage to the heart and blood vessels for six to eight weeks, the child will continue to visit a cardiologist every year or every few years. During these visits, the cardiologist may order additional blood tests to determine cholesterol and triglyceride levels.90003 90056 Long Term Forecast 90057 90002 If there is no heart failure after one year from the date of the diagnosis of Kawasaki disease, then cardiologist visits to patients are performed annually or even every few years. 90003 90002 Patients with coronary aneurysms and acquired heart defects need periodic cardiological evaluation. The frequency of such visits varies depending on the degree of coronary changes and the magnitude of the valve lesion. Often these visits are scheduled once every 6-12 months.90003 90002 With proper medical care, patients with defects and coronary changes usually have a good prognosis. Since coronary arteries and heart valves are affected in Kawasaki disease, it is advisable for patients and their families to practice a healthy lifestyle that helps prevent adult coronary heart disease in children and heart attacks and arrhythmias in children. 90003 90002 90049 Video: Kawasaki disease: diagnosis and treatment | Circulatory System and Disease | NCLEX-RN | Khan Academy 90050 90003 90002 90259 90054 90003 90262 90002 90049 5.00 90050 avg. rating (90049 93 90050% score) — 90049 1 90050 vote 90049 — votes 90050 90003 .90000 Heart disorders (acquired) — children 90001 Some children acquire a heart problem after an illness in childhood. This is called an acquired heart defect. This is different to a congenital (at birth) heart defect, which occurs when a child is born with a heart problem. 90002 The four main types of acquired heart disorder in children are: 90003 90004 90005 Kawasaki disease — an illness that occurs mainly in young children and may leave the heart muscle or coronary arteries damaged.90006 90005 Myocarditis — the heart muscle becomes inflamed and may be damaged after a viral infection. 90006 90005 Cardiomyopathy — a disease of the heart muscle, caused by a genetic disorder or after an infection. It leads to poor heart function. 90006 90005 Rheumatic heart disease — caused by rheumatic fever, this disease leads to heart muscle and valve damage. 90006 90013 90014 Kawasaki disease 90015 Kawasaki disease usually, but not always, affects children aged five years and under.It may damage the heart muscle or coronary arteries. It is named after the Japanese paediatrician who identified the disease. The cause is unknown but the disease is probably caused by an abnormal reaction to a common germ. Kawasaki disease is not contagious, although it can occur in clusters. 90016 Symptoms of Kawasaki disease 90017 The main symptom of Kawasaki disease is persistent fever (over 38.5 ° C) for five days or longer. There is usually no obvious explanation for the fever and it generally does not respond to paracetamol.Other symptoms, usually caused by inflammation of small blood vessels known as vasculitis, may include: 90004 90005 A rash, sometimes in the groin region 90006 90005 Red, swollen and cracked lips 90006 90005 Red eyes 90006 90005 Bright red, swollen tongue 90006 90005 Swollen hands and feet 90006 90005 Red rash on palms of hands and soles of feet 90006 90005 Swollen lymph nodes. 90006 90013 90016 Diagnosis of Kawasaki disease 90017 There is no test to diagnose Kawasaki disease.Diagnosis is made by excluding other possible causes of symptoms. Diagnosis may require blood tests and an echocardiogram to examine the heart for any changes in the coronary arteries. 90002 Most children who have Kawasaki disease and receive proper treatment will make a full recovery. A few children will develop heart problems, including damage to the coronary arteries. If no treatment is given, about 25 per cent of patients experience inflammation of the coronary arteries, which supply blood to the heart muscle.This can cause irregularities with these blood vessels, which may disturb the flow of blood. 90003 90016 Treatment for Kawasaki disease 90017 The treatment for Kawasaki disease is intravenous gammaglobulin (immunoglobulin), made from donated blood transfusions. Large doses of intravenous gammaglobulin will usually stop the fever and other symptoms of Kawasaki disease. Treatment should be administered within 10 days of the onset of fever to minimise heart problems. 90002 Children may also be prescribed aspirin for some weeks following the onset of Kawasaki disease, to prevent problems with coronary arteries.However, aspirin should only be given to children on the advice of a doctor, paediatrician or cardiologist. Aspirin is not usually recommended for children because of the risk of Reye’s syndrome, a rare but potentially fatal disease. 90003 90014 Myocarditis 90015 Myocarditis is an inflammation of the heart muscle. Infections can damage the heart’s cells. The normal immune system response is to attack the organism. However, in some children this immune system attack is too aggressive and destroys heart muscle cells as well as the ‘foreign’ organism.90002 The heart muscle can thicken and swell as a result of this immune response. The damaged heart muscle cells may heal, or may form scar tissue. If a large part of the heart is affected, its ability to pump blood may be impaired. 90003 90002 Autoimmune diseases, medications and chemicals can trigger myocarditis. However, in most children myocarditis is triggered by an infection, usually viral. Possible causes of infection include: 90003 90004 90005 Influenza (flu) 90006 90005 Glandular fever 90006 90005 Rheumatic fever 90006 90005 Rubella 90006 90005 HIV 90006 90005 Diphtheria.90006 90013 90016 Symptoms of myocarditis 90017 90064 There is no specific test for myocarditis, and there may be no obvious symptoms. 90064 Symptoms, when they do occur, may not be easy to detect. Symptoms may include: 90004 90005 Poor circulation, showing as cold hands and feet 90006 90005 Skin discolouration in blue or grey tones 90006 90005 Decreased urine production, due to impaired kidney function 90006 90005 Chest pain and palpitations 90006 90005 Fever 90006 90005 Swelling in the face, feet or legs.90006 90013 90016 Diagnosis of myocarditis 90017 Tests used to diagnose myocarditis may include: 90004 90005 X-rays, including chest x-rays. This may show whether the heart is enlarged or if there is fluid in the lungs 90006 90005 Electrocardiogram 90006 90005 Echocardiogram or heart ultrasound 90006 90005 Blood tests to assess kidney and liver function 90006 90005 Heart biopsy — this requires a catheter to be inserted through a leg blood vessel to obtain a tiny piece of heart muscle.90006 90013 Many children will recover completely from myocarditis, but some may develop significant heart failure. In rare cases, patients can develop blood clots that lead to stroke or heart attack, or may develop serious heart arrhythmia, which can be fatal. 90016 Treatment for myocarditis 90017 There is no cure for myocarditis. Treatment focuses on the underlying cause, as well as supporting the heart to function and maintain adequate circulation. Treatment can include: 90004 90005 Medication to control blood pressure and body fluids (diuretics) 90006 90005 Intravenous immunoglobulin or purified antibodies, to reduce inflammation 90006 90005 Bed rest and avoiding strenuous physical activity.90006 90013 Immunisations against the viral diseases that can trigger myocarditis, including rubella and influenza, are an important way to prevent this and other acquired heart disease in children. 90014 Cardiomyopathy 90015 Cardiomyopathy is a disease of the heart muscle. There are three main types: 90004 90005 Dilated cardiomyopathy — an enlargement of one or more of the heart’s chambers 90006 90005 Hypertrophic cardiomyopathy — a thickening of the heart’s muscle 90006 90005 Restrictive cardiomyopathy — the heart muscle becomes more rigid.90006 90013 In most cases of cardiomyopathy in children, the cause is unknown. However, possible factors include: 90004 90005 Heart valve problems 90006 90005 Viral infections that trigger myocarditis 90006 90005 A family history of cardiomyopathy 90006 90005 Genetic disorders including Noonan syndrome. 90006 90013 90016 Symptoms of cardiomyopathy 90017 Symptoms of cardiomyopathy vary. Some people, including children, have no symptoms in the earlier stages. Symptoms, where they occur, may include: 90004 90005 Swelling of the hands and feet 90006 90005 Swelling of the abdomen with fluid 90006 90005 Breathlessness 90006 90005 Fatigue 90006 90005 Irregular heart rhythm 90006 90005 Dizziness, light-headedness and fainting during physical activity.90006 90013 90016 Diagnosis of cardiomyopathy 90017 Tests to diagnose cardiomyopathy may include: 90004 90005 Chest x-ray 90006 90005 Electrocardiogram 90006 90005 Echocardiogram 90006 90005 Blood tests 90006 90005 Cardiac catheterisation. 90006 90013 90016 Treatment for cardiomyopathy 90017 Treatment will depend on the type of cardiomyopathy diagnosed. Treatment may include: 90004 90005 Medications — angiotensin-converting enzyme (ACE) inhibitors, diuretics and beta blockers to improve the heart’s pumping capability 90006 90005 Devices — a pacemaker to coordinate the contractions between the left and right ventricle, or an implantable cardioverter defibrillator (ICD) to monitor the heart rhythm and deliver electrical shocks to control abnormal, rapid heartbeats 90006 90005 Surgery and transplant — a heart transplant, which may be an option for patients with advanced symptoms or who have not been successfully treated by other measures.90006 90013 90014 Rheumatic heart disease 90015 90064 Rheumatic heart disease is caused by acute rheumatic fever. This disease can cause long-term damage to the heart muscle or heart valves, especially repeated and untreated episodes. Early diagnosis and treatment of acute rheumatic fever can prevent rheumatic heart disease. 90002 Acute rheumatic fever is a delayed complication of streptococcal disease, a throat infection with group A streptococcus bacteria. Only a small number of people infected with the bacteria will develop acute rheumatic fever, but the risk increases if the infection is not treated, usually with penicillin.90003 90002 Acute rheumatic fever is rare in Australia, except among Aboriginal and Torres Strait Islander children and young people where the rate of infection is high. The incidence of acute rheumatic fever in Aboriginal and Torres Strait Islander children aged between five and 14 years varies between 250 and 350 per 100,000 of population. 90003 90016 Symptoms of acute rheumatic fever 90017 Symptoms of acute rheumatic fever can include: 90004 90005 Fever 90006 90005 Joint pain and swelling 90006 90005 Carditis (inflammation of the heart).90006 90013 90016 Treatment for acute rheumatic fever 90017 90064 Acute rheumatic fever is treated with medication, usually antibiotics including penicillin. Children with the fever are usually hospitalised. 90002 Where the disease has damaged heart valves (rheumatic heart disease), surgery may be needed to repair or replace damaged valves. 90003 90014 Heart problems and medication 90015 All children with heart defects should be given antibiotics when they have teeth removed or when they have other surgery which involves the mouth, nose, intestinal organs or genito-urinary systems.Bacteria may enter the bloodstream during these procedures and can cause serious infection (known as infective endocarditis) in the abnormal part of the heart. 90002 All medications should be checked with your pharmacist, doctor or cardiologist. The usual immunisations should be given at the normal times after advice from your doctor. 90003 90014 Where to get help 90015 90004 90005 Your family doctor 90006 90005 NURSE-ON-CALL Tel. 1300 60 60 24 — for expert health information and advice (24 hours, 7 days) 90006 90005 A paediatric cardiologist (your doctor can refer you) 90006 90005 HeartKids Victoria Inc.Tel. (03) 9513 9030 90006 90013 90014 Things to remember 90015 90004 90005 An acquired heart defect develops in children after a disease. 90006 90005 There are four types of acquired heart defect. 90006 90005 All children with heart defects have special needs when taking medication. 90006 90013 .