Clinical characteristics of myocardial infarction following Kawasaki disease: report of 11 cases.

Between 1979 and 1984, 11 patients with myocardial infarction following Kawasaki disease were seen in our hospital. There were seven boys and four girls, aged from 3 months to 6 years. This cardiovascular complication developed in the early stage, from 19 days to 6 months of illness, in all but three patients. Significant clinical symptoms were recognized in only five patients. Two patients died, the conditions of two are well controlled with anticongestive therapy, and the remaining patients are asymptomatic. The diagnosis of myocardial infarction was confirmed by the following clinical findings: typical ECG patterns (10/11), abnormality of the left ventricular wall movement by serial two-dimensional echocardiography (9/10), elevated value of cardiac enzymes (6/6), perfusion defect by thallium 201 myocardial scintigraphy (6/8), and coronary artery occlusion or ventricular aneurysm by angiocardiography (9/9). All patients had markedly dilated and multiple coronary aneurysms during the course of the illness. Because myocardial infarction is frequently associated with the rapidly dilating coronary artery during the acute stage, ECG monitoring, preparation of resuscitation equipment, and use of antithrombotic agents are recommended for those high-risk patients. When a myocardial infarction has been diagnosed, measures including cardiac monitoring, use of vasodilators, inotropic agents, and urokinase may be valuable.