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Risk Levels of Dajani et al for Coronary Artery Lesions Detected in a Patient with Kawasaki Disease on Echocardiography

Purpose: To evaluate the coronary arteries of a patient with Kawasaki disease using echocardiography as reported by Dajani et al.

Description

Dajani et al correlated the findings in coronary arteries by echocardiography in patients with Kawasaki Disease with prognostic risk groups. These can help identify patients who may benefit from closer monitoring and more aggressive management. The authors are from the American Heart Association.


Changes in the Coronary Arteries

Risk Group

no changes at any stage of the disease

I

transient ectasia that disappears during the acute illness

II

single small to medium aneurysm

III

multiple small to medium aneurysms without obstruction

IV

one or more giant coronary artery aneurysms

IV

obstruction in one or more coronary arteries

V

 

 

Risk Group

Pharmacologic Therapy

Restrictions on Physical Activity

I

none after first 6-8 weeks

none after first 6-8 weeks

II

none after first 6-8 weeks

none after first 6-8 weeks

III

aspirin therapy until abnormalities resolve; may be continued longer in some patients

age dependent

IV

long-term aspirin therapy, consider warfarin

age dependent

V

long term aspirin therapy, consider warfarin; consider use of calcium channel blockers

most strenuous exercise; physical activity guided by cardiac studies

 

where:

• Aspirin therapy is 3 to 5 mg per kg per day.

• For patients in first decade and in Risk Group III or IV, no restrictions in physical activity are needed after the initial 8 weeks.

• For a patient in the second decade or older and in Risk Group III, competitive contact sports with endurance training are discouraged. Physical activity should be guided by the results of stress testing.

• For a patient in the second decade or older and in Risk Group IV, strenuous activities are discouraged. If no ischemia is found on cardiac studies then noncontact recreational sports can be allowed.

 

Risk Group

Follow-up

Invasive Testing

I

none after first year unless cardiac disease suspected

none

II

for first year; consider seeing patient every 3 to 5 years

none

III

annual with ECG and echocardiography; stress testing every other year if active

angiography if arterial stenosis suspected

IV

annual with ECG, chest X-ray and echocardiography; consider pharmacologic stress test for patient in first decade

angiography if arterial stenosis suspected; elective catheterization may be indicated in selected patients

V

ECG and echocardiography every 6 months; annual Holter monitor; annual stress test

angiography to select therapy or with no or worsening ischemia

 


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Specialty

Objective

ICD-10