SEQUENCE OF HISTORY IS BASED ON THE BLUEBOOK READ THE NOTES!!!!!! ADD INFO AS NEEDED RED: Incomplete data.

Check chart. BLUE: comments GOOD LUCK!

CARDIO CONFERENCE
Calimag, Angela Parana, Rowena Y. Perlas, Carlo Queyquep, Valerie Joy G. Racoma, Jan Michael D. Ramos, NIna

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:

 Modified Developmental Checklist: Dental eruptions: Other behavioral problems (urinary continence; toilet training; tantrums):

V. PERSONAL HISTORY: Developmental/ Behavioral History

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, (+) milkmaids 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

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 twicedaily instead

less effective than benzathine penicillin G.

Erythromycin (250 mg) twice daily

Penicillin allergic patients

Secondary Prevention

ANCILLARY PROCEDURES

CBC with Platelet Count

Hgb RBC HCT 120 4.30 0.36 WBC Differential Count Metamyelocyt es -Bands -Segmented Lymphocytes Monocytes Eosinophils Basophils 10.80 0.61 -

MCV MCHC RDW MPV Platelet

82.40 27.80 33.70 6.40 429

0.61 0.35 0.04 -

Blood Chemistry
ASO 592.86

Chest X-Ray

ECG

2D ECHO