ACQUIRED HEART

DISEASE

Primary myocardial
disease(Cardiomyopathy)

Hypertrophic cardiomyopathy
Dilated(congestive)
cardiomyopathy
Endocardial fibroelastosis
Doxorubicin cardiomyopathy
Restrictive cardiomyopathy
Right ventricular dysplasia
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Cardiovascular
infection

Infective endocarditis (subacute

bacterial endocarditis)
Myocarditis
Pericarditis
Constrictive pericarditis

Kawasaki disease
(mucocutaneous lymph node
syndrome)
Acute Rheumatic Fever
Valvular heart disease
Cardiac tumor
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Doxorubicin
cardiomyopathy

Most common chronic CHF

Risk factor:
Age<4 years
Cumulative dose >400600mg/m2
A regimen larger,infrequent doses
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Pathophysiologic
features

Dilated LV with decreased

contractility
Elevated filling pressure
Reduced CO

Clinical manifestations

Asymptomatic,2-4 mo signs of CHF

Hepatomegaly,distended neck vein
Gallop rhytm,soft systolic murmur
of MR,TR
CXR: cardiomegaly
ECG sinus tachycardia

Echo: dilated LV,decreased

contractility
Symptomatic cm: high mortality
rate
Die by 9 y after onset of the
illness

management

Anticongestive measures with

digoxin,diuretics,after load reducing agents
Doxocontinuous infusion
Close monitoring for cardiac toxicity by
echo,angio,biopsy
Beta blockers (metoprolol
0,1mg/kg/dose/bid max.dose 0,9mg/kg/day
Cardiac transplantationselected pts

Infective endocarditis
1. Presence of structural abnormalities of the heart or great arteries
with significant pressure gradient or turbulence
2. Bacterimia, even transient
* Almost all patients have a history of CHD or AHD
* Any localized infection (eg. Abscess, osteomyelitis, pyelonephritis )
can seed organism into the circulation
* Bacterimia frequently results after dental procedures
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Pathology
Vegetation of infective endocarditis is usually found on the
low pressure side of the defect
Exp : in PDA, vegetations are found in the PA ( Pulmonary Artery )

Microbiology
- Streptococcus viridans, Enterococci and Staphylococcus aureus
are responsible for > 90% of the cases
- After dental procedures : S. viridans
- After genitourinary surgery : Enterococci
- Post operative endocarditis : Staphylococci
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Clinical manifestation
Heart murmur is universal (100%)
- Fever (38,30 39,40 C)
- Splenomegaly is common (75%)
- Skin manifestation : petechiae, Oslers node
- Embolic phenomena
- Sign of heart failure may be present as the complication
LAB:
- Positive blood cultures are found in > 90% of patients
in the absence of previous antimicrobial therapy
- Anemia, Leukocytosis
- Sedimentation rate is increased
- Microscopic hematuria is found in 30% of patients

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- Presumptive: underlying heart disease with FUO

- Definitive:
positive blood culture
Management:
3 to 5 blood cultures are drawn in succession over 24-48 hours
unless the patient is very ill
Empirical therapy : Penicillin, aminoglycoside & vancomycin
Final selection antibiotics :
- S. viridans : IV penicillin (4 weeks)
- Staphylococcal : oxacillin, methicillin, cloxacillin
- Enterococcus : ampicillin + gentamicin
- Fungal infections : amphotericin B
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The overall recovery rate is 80-85%

- Prevention:
- The most important
- Maintenance of good oral hygiene is more important than
antibiotic prophylaxis
- Endocarditis prophylaxis is indicated for certain cardiac
conditions & procedures
- The antibiotic prophylaxis is given orally 1 hour before a
procedure, parenteral antibiotics are given within 30 minutes
of starting a procedure
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Cardiac tumor
1. Extremely rare in pediatric age group
2. The most common is RHABDOMYOMA
- Infants < 1 yr old > 75% are rhabdomyomas & teratomas
- Children 1-15 yr old 80% rhabdomyomas, fibromas and
myxomas
3. More than 90% of primary tumors are benign
4. Primary malignant tumors are extremely rare in infants and
children
5. Secondary malignant tumors also rare in children
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- Non specific & vary primarily with the location of the tumor
- Syncope or chest pain may be a presenting complaint
- Sudden unexpected death
- Altered contour of the heart on X-Ray
- Non specific ST-T changes on ECG
- Accurate determination of the presence, extent & location
of the tumor with echo and doppler
SURGERY is the only treatment for cardiac tumors

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Thank you

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