Page 149 - Clinical Pearls in Cardiology

Heart Disease and Fever 137

in arterial pulse (like radioradial or radiofemoral delay)
and blood pressure and arterial bruits are the most
common physical examination clues. Aneurysms are
most common and clinically most significant in the
aortic root, where they can lead to aortic regurgitation.
Occurrence of such symptoms and signs in the setting
of an elevated ESR indicates active disease. Almost all
patients with this disease improve when treated with high
doses of corticosteroids (e.g. prednisone, 1 mg/kg/day).
16. How can sudden death occur in a case of Kawasaki
disease?
In untreated cases of Kawasaki disease, coronary artery
aneurysms occur in 20 to 25% of cases. Aneurysms
usually appear 1 to 4 weeks after the onset of fever. New
aneurysms seldom form after 6 weeks. Aneurysms are
more common in the proximal than distal coronary
arteries. Giant aneurysms are the ones that are most likely
to thrombose and occlude, leading to myocardial infarction
and even sudden death. Myocardial infarction occurs most
commonly in the first year after illness, but may also occur
years later. However, most of the smaller aneurysms will
undergo angiographic regression within 1 to 2 years.
17. What do you know about atrial myxoma?
Cardiac myxoma is the most common primary tumor
of the heart. About 75% of cardiac myxomas are located
in the left atrium, and 25% are located in the right
atrium. Familial myxomas occur as part of the Carney
complex (consists of myxomas, pigmented skin lesions
and endocrine neoplasms). Patients with myxoma can
present in the following ways;
• Systemic symptoms like fever, malaise, weight loss
• Signs of peripheral or pulmonary embolization