Title: Pediatric Cardiology / Kawasaki
Tags: kawasaki peds-cardio high-yield treatment aspirin coronary diagnosis epidemiology criteria giant-aneurysm incomplete prognosis z-score activity anatomy aneurysm anticoagulation classification clinical complications echo follow-up infant ivig labs refractory risk-stratification sports

Q: What are the 5 principal clinical features of Kawasaki Disease (besides fever)?
A: 1) Bilateral bulbar conjunctival injection (non-exudative), 2) Oral mucous membrane changes (strawberry tongue, cracked lips), 3) Peripheral extremity changes (edema, erythema, desquamation), 4) Polymorphous rash, 5) Cervical lymphadenopathy (≥1.5 cm, usually unilateral)

Q: What defines complete Kawasaki Disease?
A: Fever ≥5 days PLUS ≥4 of 5 principal clinical features

Q: What Z-score threshold defines a coronary artery aneurysm in Kawasaki Disease?
A: Z-score ≥2.5

Q: What is the first-line treatment for Kawasaki Disease?
A: IVIG 2 g/kg as a single infusion over 10-12 hours PLUS high-dose aspirin (80-100 mg/kg/day divided QID)

Q: When should high-dose aspirin be transitioned to low-dose aspirin in Kawasaki Disease?
A: After patient is afebrile for 48-72 hours

Q: What is the low-dose aspirin dose for Kawasaki Disease and how long should it continue?
A: 3-5 mg/kg/day; continue for minimum 6-8 weeks (until confirmed no coronary artery abnormalities), or indefinitely if aneurysms present

Q: What defines a "giant" coronary artery aneurysm in Kawasaki Disease?
A: Z-score ≥10 OR absolute dimension ≥8 mm

Q: Which patients with Kawasaki Disease are considered HIGH RISK and need treatment intensification?
A: Z-score ≥2.5 at diagnosis, age <6 months, high Kobayashi score (Japan), or evidence of MAS

Q: What is the treatment for IVIG-refractory Kawasaki Disease?
A: Second dose of IVIG 2 g/kg, OR infliximab 5 mg/kg IV, OR methylprednisolone (2 mg/kg/day or 30 mg/kg pulse)

Q: What long-term anticoagulation is recommended for giant aneurysms in Kawasaki Disease?
A: Aspirin PLUS warfarin (target INR 2.0-3.0) OR aspirin plus LMWH

Q: Which coronary arteries are most commonly affected in Kawasaki Disease?
A: Proximal LAD (left anterior descending) and proximal RCA (right coronary artery)

Q: What cardiac complication can occur in the acute phase of Kawasaki Disease besides coronary aneurysms?
A: Myocarditis (common, usually subclinical), pericarditis, valvular regurgitation (usually mitral), coronary artery ectasia

Q: At what intervals should echocardiograms be performed for Kawasaki Disease?
A: At diagnosis, at 1-2 weeks, and at 4-6 weeks after treatment. More frequent if abnormalities detected.

Q: What laboratory findings support the diagnosis of incomplete Kawasaki Disease?
A: CRP ≥3 mg/dL AND/OR ESR ≥40 mm/hr, PLUS ≥3 of: Anemia for age, Platelet count ≥450,000 after day 7, Albumin ≤3 g/dL, Elevated ALT, WBC ≥15,000, Urine ≥10 WBC/hpf

Q: What percentage of untreated Kawasaki Disease patients develop coronary artery aneurysms?
A: 15-25%

Q: What percentage of Kawasaki Disease patients develop coronary abnormalities despite IVIG treatment?
A: 2-5%

Q: What is the PHN Z-score classification for a coronary Z-score of 3.5 in Kawasaki Disease?
A: Small aneurysm (Z-score 2.5 to <5.0)

Q: A 3-month-old infant has 6 days of fever, conjunctival injection, and irritability. CRP is 8 mg/dL. What should you do?
A: Consider incomplete Kawasaki Disease; obtain echocardiogram and supplemental labs. Age <6 months is HIGH RISK - treat with IVIG if echo or labs supportive.

Q: What activity restrictions apply to patients with giant coronary aneurysms from Kawasaki Disease?
A: Avoid contact/collision sports and isometric exercise; stress testing before participation recommended; individualized based on functional status

Q: What is the most common cause of acquired heart disease in children in developed countries?
A: Kawasaki Disease