Kawasaki disease is prone to coronary artery disease, ultrasound diagnosis is critical

  Kawasaki disease, also known as mucocutaneous lymph node syndrome, usually occurs in children between 6 months and 5 years old. Specific damage to the coronary arteries is its most important complication. It has become the main cause of childhood acquired coronary artery disease. One of the causes of acute coronary syndrome in young people. According to statistics, in untreated cases of Kawasaki disease, the incidence of coronary artery dilation is 18.6%-26.0%. Once coronary artery injury is caused, it is necessary to monitor the changes of coronary artery and myocardial perfusion for life, so continuous and non-invasive diagnosis is of great significance. What can play an important role in this regard is ultrasound.
  In the early stage of Kawasaki disease, patients will have symptoms of high fever, and this high fever will last for more than 5 days, some may be as long as two weeks, and some high fever will reappear within two days after it subsides. After a high fever continues for a period of time, the patient’s face will appear red, swollen, and painful. There will also be many maculopapular rashes of various sizes and shapes on the body, but these maculopapular rashes are not painful or itchy; the conjunctiva will appear Symptoms of congestion, a small number of patients will be complicated by purulent conjunctivitis; lip swelling, chapped and bleeding symptoms will also appear, the tongue presents the shape of bayberry tongue, oral mucosa is congested, but there will be no ulcer symptoms. In addition, Kawasaki disease can also cause serious cardiovascular complications such as coronary artery dilation and myocardial damage, which often reach a peak after 6 weeks of onset. Thereafter, the coronary artery will undergo lifelong dynamic pathological changes, including coronary artery dilation, coronary artery aneurysm, and stenosis. , Occlusion and atherosclerosis, thrombosis at the aneurysm, severe cases of myocardial infarction, ischemic heart disease, and even sudden death. Therefore, as soon as parents find that their child has a persistent high fever, they must immediately send to the doctor, so that Kawasaki disease can be detected early.
  Laboratory examination and auxiliary examination are the two methods of Kawasaki disease. Laboratory tests are mainly serological tests. If the patient’s white blood cell count, platelet count, erythrocyte sedimentation rate, and C-reactive protein increase, combined with clinical symptoms, Kawasaki disease can be diagnosed. The auxiliary examination mainly refers to the electrocardiogram and ultrasound examination, and the main purpose is to check whether the patient has cardiovascular complications. Through echocardiographic examination, the patient’s heart structure and the size of the heart cavity can be seen, and the patient’s right coronary artery, the left main coronary artery and the left anterior descending branch can be detected to determine whether the coronary arteries are dilated and the arterial intima is smooth. Whether the wall of the tube is thickened, so that the patient can be diagnosed with coronary artery dilation, coronary aneurysm and other cardiovascular complications.
  Normal children under 3 years old have coronary artery diameter <2.5mm, 3-9 years old <3mm, 9-14 years old <3.5mm. Small coronary artery dilation or coronary aneurysm refers to: coronary artery dilated inner diameter ≤ 4mm or older children (≥ 5 years old) coronary dilated inner diameter less than 1.5 times of normal; middle coronary artery tumor: coronary artery inner diameter> 4mm and ≤ 8mm Or older children (≥5 years old) with an enlarged coronary artery diameter of 1.5 to 4 times larger than normal; giant coronary aneurysms: coronary artery enlargement with an inner diameter> 8 mm or older children (≥ 5 years old) with an enlarged coronary artery diameter greater than normal 4 Times.
  Compared with coronary angiography, although echocardiography has certain limitations in detecting the full picture of coronary arteries, it has higher sensitivity and specificity to coronary artery disease; in addition, ultrasound diagnosis has high safety and no It is painful, non-invasive, convenient and intuitive, and can be performed multiple times. It is very suitable for children with small coronary artery volume, high heart rate, unable to hold their breath, and sensitivity to radiation, requiring low-dose inspection. Therefore, ultrasound diagnosis is currently the main method for diagnosing heart and coronary artery lesions in patients with Kawasaki disease.
  Current clinical recommendations: Coronary ultrasound is the first choice and necessary for acute Kawasaki disease, especially for atypical cases lacking clinical manifestations. The diagnosis is of decisive significance; for simple cases, even if the echocardiogram is normal in the first week of onset, it is not The possibility of advanced coronary artery aneurysm is ruled out, so it should be reviewed 1 to 2 weeks and 6 to 8 weeks after the diagnosis and treatment of Kawasaki disease; patients with coronary artery dilation should be reviewed at least twice a week until the size is stable; large aneurysms, even if they are large Stable, echocardiographic monitoring should also be performed within 3 months before the onset; even if the infants under 6 months of age are treated in time, they still need regular echocardiographic monitoring until the size is stable; for high-risk clinical features (such as persistent fever, Patients with IVIG resistance) should undergo ultrasound monitoring more frequently.