title: Acute myocardial ischemia in adults secondary to missed Kawasaki disease in childhood.
abstract: Coronary artery aneurysms that occur in 25% of untreated Kawasaki disease (KD) patients may remain clinically silent for decades and then thrombose resulting in myocardial infarction. Although KD is now the most common cause of acquired heart disease in children in Asia, the United States, and Western Europe, the incidence of KD in Egypt is unknown. We tested the hypothesis that young adults in Egypt presenting with acute myocardial ischemia may have coronary artery lesions because of KD in childhood. We reviewed a total of 580 angiograms of patients ≤40 years presenting with symptoms of myocardial ischemia. Coronary artery aneurysms were noted in 46 patients (7.9%), of whom 9 presented with myocardial infarction. The likelihood of antecedent KD as the cause of the aneurysms was classified as definite (n = 10), probable (n = 29), or equivocal (n = 7). Compared with the definite and probable groups, the equivocal group had more traditional cardiovascular risk factors, smaller sized aneurysms, and fewer coronary arteries affected. In conclusion, in a major metropolitan center in Egypt, 6.7% of adults aged ≤40 years who underwent angiography for evaluation of possible myocardial ischemia had lesions consistent with antecedent KD. Because of the unique therapeutic challenges associated with these lesions, adult cardiologists should be aware that coronary artery aneurysms in young adults may be because of missed KD in childhood.
authors.affiliation: Department of Cardiology, Kasr El Aini Hospital, Faculty of Medicine, Cairo University, Egypt. Electronic address: sherifrizk@hotmail.com.
authors.forename: Sherif R Y
authors.initials: SR
authors.lastname: Rizk
authors.affiliation: Department of Cardiology, Kasr El Aini Hospital, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Galal
authors.initials: G
authors.lastname: El Said
authors.affiliation: Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.affiliation: Department of Pediatrics, University of California San Diego, La Jolla, California; Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, California.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Burns
authors.affiliation: Department of Pediatrics, University of California San Diego, La Jolla, California; Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, California.
authors.forename: Howaida
authors.initials: H
authors.lastname: El Said
authors.affiliation: Department of Cardiology, Kasr El Aini Hospital, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Khaled A
authors.initials: KA
authors.lastname: Sorour
authors.affiliation: Department of Cardiology, Kasr El Aini Hospital, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Soliman
authors.initials: S
authors.lastname: Gharib
authors.affiliation: Department of Cardiology, Sharp Memorial Hospital and San Diego Cardiac Center, San Diego, California.
authors.forename: John B
authors.initials: JB
authors.lastname: Gordon
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017023:Coronary Angiography; D003951:Diagnostic Errors; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000175:diagnosis; D061330:Multidetector Computed Tomography; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult