Kawasaki Disease: Cardiac Problems and Management

Kawasaki disease or mucocutaneous lymph node syndrome is an acute febrile illness recognized most often in children younger than 4 years of age. It is characterized by mucosal inflammation, indurative edema of the hands and feet, skin rash, and cervical lymphadenopathy. The diagnostic criteria prepared by the Kawasaki disease research committee supported by the Ministry of Health and Welfare of the Japanese government are shown in Table 1. These criteria make up the characteristic symptoms and laboratory findings of the disease. It was first described as a clinical entity in Japan in 1967, by Dr Tomisaku Kawasaki (Fig 1). Kawasaki disease has been most prevalent in Japan; however, it has now been recognized in the United States and other countries. Kawasaki disease has aroused intense interest because of the catastrophic sequelae: coronary arteritis accompanied by coronary aneurysms and thrombotic occlusion which may lead to sudden death or ischemic heart disease. In the early days, the prognosis for individuals with Kawasaki disease was considered to be good. However, the first nationwide survey in Japan in 1971 clarified that 1.7% of the patients had died from acute heart failure or myocardial infarction, and all autopsies had shown coronary arteritis accompanied by aneurysms and thrombotic occlusion.