Acute myocardial infarction in young patient probably due to Kawasaki disease

Lee, Sun Young; Park, Jeong Euy

doi:10.4070/kcj.2001.31.1.119

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…The significance of coronary outcomes emphasizes the importance of early aggressive management of IVIG-resistant KD. CAD occurs significantly more frequently in IVIG-resistant KD than in the IVIG-responsive group 28)29). This study also showed a higher incidence of CAD in the IVIG-resistant group.…”

Section: Discussionsupporting

confidence: 67%

Predicting Factors for Refractory Kawasaki Disease

Kim

Chun

et al. 2010

Korean Circ J

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Background and ObjectivesAbout 10-15% of Kawasaki disease (KD) is refractory to intravenous immunoglobulin (IVIG) therapy. This study was designed to investigate the predicting factors for refractory KD.Subjects and MethodsWe reviewed retrospectively the clinical records of 77 patients with typical KD admitted at Wonju Christian Hospital from January, 2005, to December, 2008. The variance of laboratory and demographic parameters between the IVIG-responsive group and IVIG-resistant group were analyzed. Thirteen patients with urinary tract infections were randomly collected as a febrile control group.ResultsAmong 77 patients diagnosed with complete KD, 13 patients (16.9%) were IVIG-resistant. The febrile period and hospital days were significantly longer in the IVIG-resistant group than IVIG-responsive group (p<0.001, p=0.002). Serum levels of albumin and sodium were significantly lower in the IVIG-resistant group (p=0.025). The Kobayashi score could differentiate these two groups (p=0.015). Fewer lymphocytes was observed during the subacute phase in the IVIG-resistant group (p=0.032). Coronary arterial dilatations (CADs) were observed in 10.9% (7/64) of IVIG-responders and 38.5% (5/13) of IVIG-resistant patients (p=0.038).ConclusionThe percentage of neutrophils and lymphocytes in patients with KD, in addition to known risk factors for refractory KD, may help predict IVIG-resistance in patients with KD.

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Section: Discussionsupporting

confidence: 67%

Predicting Factors for Refractory Kawasaki Disease

Kim

Chun

et al. 2010

Korean Circ J

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“…They suggest that there are no significant differences between normal coronary arteries of well-treated KD patients and healthy people 8)16)17). Even in KD patients with good responses to IVIG, CAL still occasionally occurs 18-21). High echodensity of the coronary arterial wall was demonstrated at a mean of 5.4 days from onset.…”

Section: Discussionmentioning

confidence: 97%

“… 8) 16) 17) Even in KD patients with good responses to IVIG, CAL still occasionally occurs. 18 - 21) High echodensity of the coronary arterial wall was demonstrated at a mean of 5.4 days from onset. Without IVIG therapy, diffuse coronary artery dilatation was observed in 50% of KD patients at about 9.5 days after onset of symptoms, diffuse coronary artery dilatation progresses to aneurysms in 28.8% by 11.4 days, and resolution of coronary artery dilatation occurs within 30 days of onset of transient dilation.…”

Section: Discussionmentioning

confidence: 99%

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Affects of "Age at Diagnosis" on Coronary Artery Lesions in Patients With Incomplete Kawasaki Disease

2010

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Background and ObjectivesDiagnosis of Kawasaki disease (KD) is based on 5 clinical features. Incomplete KD (IKD), which has fewer features, is more common in infants and older children, in whom the rate of coronary artery aneurysms is paradoxically higher. We conducted this study to evaluate risk factors associated with age-at-diagnosis on coronary arterial lesions (CAL) in patients with IKD.Subjects and MethodsRetrospective data from 396 patients with KD in a single center were collected from January 2003 to July 2007. Patients were grouped according to their age at diagnosis; Group A (<1 year of age), Group B (1≤age<5 years of age), and Group C (≥5 years of age).ResultsAmong a total of 396 patients with KD, 87 (22.0%) were in Group A, 246 (62.1%) in Group B, and 63 (15.9%) in Group C. In groups A and C, lag times for starting intravenous immunoglobulin (IVIG) were longer than in Group B. There were no differences in the incidence of IKD, late CAL, or rates of IVIG retreatment among the three groups. Among 174 patients with IKD, there were no age-related differences in late CAL incidence or IVIG retreatment. Compared with typical KD, duration of fever and lag times to start IVIG were longer, and the rate of IVIG retreatment was higher in IKD, but there was no difference in the risk of CAL between typical KD and IKD.ConclusionIn the management of KD, especially the incomplete type, age-associated factors appear not to be significant for predicting the development of CAL.

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“…In Korea, there have been reports of ischemic heart disease as late cardiologic sequelae of KD. [15][16][17] In our case, AMI occurred at the subacute phase of KD just after subsiding fever. In fact, the subacute phase is the period of highest risk of sudden death in KD patients, [18] and the early mortality results from coronary complications, mainly aneurysmal thrombosis with myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction during the Subacute Phase of Refractory and Incomplete Kawasaki Disease in a Five-year-old Boy

Jin

Kim

2014

Korean J Crit Care Med

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Kawasaki disease (KD) is an acute, systemic vasculitis of childhood. The early mortality of KD results from coronary complications, mainly aneurysmal thrombosis with myocardial infarction, and the subacute phase of KD has the highest risk of mortality. Although there have been reports of ischemic heart disease as late cardiologic sequelae of KD in young adults, acute myocardial infarction caused by coronary complications in the subacute phase of KD is rare. We experienced one pediatric patient who developed coronary artery aneurysm and acute myocardiac infarction (AMI) during the subacute phase of incomplete and intravenous immunoglobulin (IVIG)-nonresponsive KD. The patient was given a good prognosis due to close monitoring and early recognition of AMI. Physicians should carefully monitor KD patients who do not respond to initial IVIG therapy and who show progressive coronary artery dilatation. If such a patient complaints of chest pain and the ECG shows hyperacute T waves, the physician should suspect development of AMI.

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Acute myocardial infarction in young patient probably due to Kawasaki disease

Cited by 5 publications

References 11 publications

Predicting Factors for Refractory Kawasaki Disease

Predicting Factors for Refractory Kawasaki Disease

Affects of "Age at Diagnosis" on Coronary Artery Lesions in Patients With Incomplete Kawasaki Disease

Acute Myocardial Infarction during the Subacute Phase of Refractory and Incomplete Kawasaki Disease in a Five-year-old Boy

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