Lifetime cardiovascular management of patients with previous Kawasaki disease

Abstract

Kawasaki disease (KD) is an inflammatory disorder of young children, associated with vasculitis of the coronary arteries with subsequent aneurysm formation in up to one-third of untreated patients. Those who develop aneurysms are at life-long risk of coronary thrombosis or the development of stenotic lesions, which may lead to myocardial ischaemia, infarction or death. The incidence of KD is increasing worldwide, and in more economically developed countries, KD is now the most common cause of acquired heart disease in children. However, many clinicians in the UK are unaware of the disorder and its long-term cardiac complications, potentially leading to late diagnosis, delayed treatment and poorer outcomes. Increasing numbers of patients who suffered KD in childhood are transitioning to the care of adult services where there is significantly less awareness and experience of the condition than in paediatric services. The aim of this document is to provide guidance on the long-term management of patients who have vascular complications of KD and guidance on the emergency management of acute coronary complications. Guidance on the management of acute KD is published elsewhere.

Keywords: Kawasaki disease; acute coronary syndrome; cardiovascular risk; coronary artery aneurysm; late sequelae; lifetime cardiovascular management; person specific protocol; transitional care.

Figure 1

Kawasaki disease emergency management of suspected myocardial ischaemia in children with previous Kawasaki disease and possible coronary artery aneurysms. CAA, coronary artery aneurysms; nSTEMI, non-STEMI; PSP, person-specific protocol; STEMI, ST-elevation myocardial infarction.

Figure 2

Kawasaki disease emergency management of suspected myocardial ischaemia in adults with previous Kawasaki disease and possible coronary artery aneurysms. nSTEMI, non-STEMI; STEMI, ST-elevation myocardial infarction.