Related Experiment Videos
Myocardial infarction in Kawasaki disease: clinical analyses in 195 cases
Insights
Myocardial infarction (MI) in Kawasaki disease (KD) often occurs within the first year but can be delayed. Many patients experience cardiac dysfunction or fatal outcomes, highlighting the need for early detection and management of KD-associated MI.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Rheumatic Diseases
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Myocardial infarction (MI) is a serious complication of KD, with significant morbidity and mortality.
- Understanding the clinical course and outcomes of KD-associated MI is crucial for patient management.
Purpose of the Study:
- To analyze the clinical characteristics, timing, symptoms, and outcomes of myocardial infarction complicating Kawasaki disease.
- To identify risk factors and patterns of coronary artery obstruction in patients with KD-associated MI.
Main Methods:
- Retrospective analysis of clinical data from 195 patients with KD-associated MI.
- Data collected from 74 major hospitals in Japan.
- Coronary angiographic findings were reviewed.
Main Results:
- MI typically occurred within the first year of KD, but 27.2% occurred later.
- 63% of MIs happened during sleep or rest; symptoms included shock, vomiting, and abdominal pain.
- Mortality was 22% during the first attack, 16% of survivors had a second attack, and 43% of survivors had cardiac dysfunction.
Conclusions:
- Myocardial infarction in Kawasaki disease presents with varied timing and symptoms, including asymptomatic cases.
- Significant mortality and long-term cardiac dysfunction occur in patients with KD-associated MI.
- Coronary artery obstruction patterns differ between fatal and surviving cases, emphasizing the need for vigilant cardiac monitoring in KD patients.
Abstract:
We analyzed clinical data from 195 patients (141 boys) with myocardial infarction complicating Kawasaki disease, collected from 74 major hospitals in Japan. The myocardial infarction usually occurred within the first year of illness, but 27.2% of the patients had myocardial infarction more than 1 year later. In 63% of the patients it occurred during sleep or at rest. The main symptoms of acute myocardial infarction were shock, unrest, vomiting, abdominal pain, and chest pain; chest pain was much more frequently recognized in the survivors and in older patients. The myocardial infarctions were asymptomatic in 37% of the patients. Twenty-two percent of the patients died during the first attack. Sixteen percent of the survivors of a first attack had a second attack. Forty-three percent of all survivors of the first or subsequent attack are doing well; however, others have some type of cardiac dysfunction, such as mitral regurgitation, decreased ejection fraction of the left ventricle, or left ventricular aneurysm. Coronary angiographic studies indicate that in most of the fatal cases there was obstruction either in the main left coronary artery or in both the main right coronary artery and the anterior descending artery. In survivors, one-vessel obstruction was frequently recognized, particularly in the right coronary artery.