CARDIO CONFERENCE

Calimag, AngelaParana, Rowena Y.

Perlas, CarloQueyquep, Valerie Joy G.Racoma, Jan Michael D.

Ramos, NIna

SEQUENCE OF HISTORY IS BASED ON THE BLUEBOOKREAD THE NOTES!!!!!!ADD INFO AS NEEDEDRED: Incomplete data. Check chart.BLUE: comments

GOOD LUCK!

I. GENERAL DATA• Name: JM• Age: 9• Sex: Male• Race: Filipino• Birthdate: 9/10/2001• Birthplace:• Religion: Roman Catholic• Present Address: Lot 6 Block 25 Westville Homes Ligas 3 Bacoor

Cavite• Date of Admission: 2/28/2011• Informant: • Reliability:• CHIEF COMPLAINT: Jerky movement at right arm

II. CHIEF COMPLAINT

Jerky movement at right arm

III. HISTORY OF PRESENT ILLNESS

IV. REVIEW OF SYSTEMS

V. PERSONAL HISTORY: Feeding history

• Appetite:• Usual food intake and amount per day for

breakfast, lunch, middle, snacks:• ACI, RENI:• Food likes, dislikes; feeding difficulties:• Multivitamins and iron supplements: dosage

and frequency:

V. PERSONAL HISTORY: Developmental/ Behavioral History

• Modified Developmental Checklist:• Dental eruptions:• Other behavioral problems (urinary

continence; toilet training; tantrums):

VI. IMMUNIZATION HISTORY:

VII. FAMILY HISTORY

VIII. SOCIOECONOMIC HISTORY

IX. ENVIRONMENTAL HISTORY

PHYSICAL EXAM ON ADMISSION• General Survey: Conscious, coherent, ambulatory, not in cardiorespiratory

distress.• Vital Sign: BP 90/60, HR 80bpm, RR 21cpm regular, T 36.5C • Anthropometric Data: Weight 23kg, Ht 122cm• Skin: Warm moist skin, (+) multiple evanescent erythematous patch Right

forearm• Head: Normocephalic, no head asymmetry and deformity, hair well

distributed• Eyes: Pink palpebral conjunctiva, anicteric sclera, pupils 2-3mm ERTL isocoric• Ears and mastoids: No tragal tenderness, nonhyperemic EAC, no impacted

cerumen, intact tympanic membrane

PHYSICAL EXAM ON ADMISSION• Mouth and throat: Moist lips and buccal mucosae, nonhyperemic posterior

pharyngeal wall• Chest and lungs: Symmetrical chest expansion, no retractions, clear breath

sounds• Heart and vascular system: Dynamic precordium, apex beat at 5th left ICS

MCL, (+) Grade 3/6 holosystolic murmur paratesernal area, (+) heave parasternal area

• Abdomen: Flat abdomen, everted umbilicus, normoactive bowel sounds, o masses, no tenderness

• Extremities: Pulses full and equal, no edema, no cyanosis, (+) subcutaneous nodules on 1st, 2nd, 3rd, 5th PIPS right, and 2nd, 3rd PIPS left, and dorsal aspect of right pedis

PHYSICAL EXAM ON ADMISSION

PHYSICAL EXAM ON ADMISSION

PHYSICAL EXAM ON ADMISSION

PHYSICAL EXAM ON ADMISSION

NEUROLOGICAL EXAMINATION• Cerebrum: conscious, coherent, oriented to 3 spheres• Cranial Nerves:

– Pupils 2-3 mm ERTL, isocoric, (+) direct and consensual light reflex, (+) ROR, EOMS full and equal, can clench teeth, raise eyebrows, can smile, frown, (+) gag reflex, can turn head from side to side, tongue midline, (-) worming tongue

• Cerebellar: can do FTNT and APST, (+) milkmaid’s grip• Motor: 4/5 on right upper extremities, 5/5 on left upper

extremities, and bilateral lower extremities• Sensory: No deficits• Reflex: ++• Meningeal signs: none

NEUROLOGICAL EXAMINATION

PAST MEDICAL HISTORY

• No previous hospitalizations nor blood transfusions

• No known allergies

Epidemiology

• Remains the most common form of acquired heart disease in all age groups worldwide

• Accounts for 50% of all cardiovascular disease and as much as 50% cardiac admissions in developing countries

• Incidence of both initial attacks and recurrences peaks 5-15 years old

• Philippine iIncidence is 0.9/1,000 pop (check if updated)

Pathogenesis• Cytotoxic theory

• Streptolysin O has direct cytotoxic effect on mammalian cells in tissue culture

• Inability to explain the latent period between Group A Streptococcus pharyngitis and the onset of acute rheumatic fever

• Immune-mediated pathogenesis • Suggested by clinical similarity of acute rheumatic fever to

other illness produced by immunopathogenic processes and by latent period between the Group A Streptococcus infection and acute rheumatic fever

Clinical Manifestations and Diagnosis

Differential Diagnosis

• SLE• Juvenile Rheumatoid Arthritis• Infective Endocarditis

Treatment

Complications

• Long term sequalae are limited to the heart• Increased risk for developing infective

endocarditis

Prognosis

• Depends on the clinical manifestations present at the time of the initial episode, severity of the initial episode, and the presence of recurrences

• ~70%of the patients with carditis during initial episode recover with no residual heart disease

Primary Prevention

• Primary– antibiotic therapy instituted before the 9th day of

symptoms of acute GAS pharyngitis

Secondary Prevention

• Benzathine penicillin G (1.2 million units, or 600,000 units if 27 kg) delivered every 4 weeks. – Best antibiotic for secondary prophylaxis– High risk: can be given every 3 weeks, or even every 2 weeks. Settings

where good compliance with 4-weekly dosing can be achieved, more frequent dosing is rarely needed.

• Oral penicillin V (250 mg) can be given twice-daily instead – less effective than benzathine penicillin G.

• Erythromycin (250 mg) twice daily– Penicillin allergic patients

Secondary Prevention

ANCILLARY PROCEDURES

CBC with Platelet CountHgb 120 WBC 10.80

RBC 4.30 Differential Count 0.61

HCT 0.36 -Metamyelocytes -

MCV 82.40 -Bands -

MCHC 27.80 -Segmented 0.61

RDW 33.70 Lymphocytes 0.35

MPV 6.40 Monocytes -

Platelet 429 Eosinophils 0.04

Basophils -

Blood ChemistryASO 592.86

Chest X-Ray

ECG

2D ECHO