Secondary prevention
In the case of KD, long-term management and secondary prevention overlap. In 2019, the American Heart Association (AHA) made general recommendations for cardiovascular risk reduction in high-risk pediatric patients, including those with KD.[75] However, the authors of this topic suggest following the more detailed long-term management recommendations from the 2017 AHA guidelines.[89]
Promote healthy lifestyle and activity at every visit.
Use an alternative antiplatelet agent such as clopidogrel if long-term treatment with aspirin is indicated but the patient cannot tolerate, or is resistant to, aspirin.
Restrict physical contact sports in patients on anticoagulation or dual antiplatelet therapy. Participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischemia or exercise-induced arrhythmias.
Assess cardiovascular risk factors including blood pressure, fasting lipid profile, body mass index, waist circumference, diet, activity, and smoking at time intervals appropriate to the disease severity.
Include history and physical exam, echocardiography, and electrocardiography in follow-up cardiology assessment at time intervals appropriate to the disease severity.
Include stress echocardiography, stress with magnetic resonance imaging (MRI), stress nuclear medicine, or positron emission tomography in additional cardiology assessment to detect inducible myocardial ischemia at time intervals appropriate to the disease severity.
Include angiography by computed tomography, MRI, or invasive angiography if further imaging is needed at time intervals appropriate to the disease severity.
Discourage oral contraceptive use in patients who have ever had medium aneurysms, or larger (Z score ≥5), and who still have small aneurysms (Z score ≥2.5) or larger. Advise that pregnancy be supervised by a multidisciplinary team including a cardiologist, and that anticoagulants or antiplatelet therapy may require adjustment during pregnancy or delivery.
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