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