Transient Q-waves in an infant with asymptomatic myocardial infarction due to Kawasaki disease

Cardiol Young. 2019 Feb;29(2):231-234. doi: 10.1017/S1047951118001919. Epub 2018 Dec 6.

Abstract

Giant coronary artery aneurysms are a complication of Kawasaki disease and can be fatal if associated with thrombosis. We describe the clinical outcome of a boy with Kawasaki disease who exhibited "supergiant" coronary artery aneurysms at the age of 14 months and, despite treatment with anticoagulant and antiplatelet medication, developed a left coronary artery thrombosis and presented following a myocardial infarction at 2 years old. Although his symptoms were minimal, the myocardial infarction was identified by abnormal Q-waves and giant negative T-waves in precordial leads of routine electrocardiography. Intensive anticoagulant therapy combining heparin injections and high-dose warfarin was successful. The abnormal Q-waves and negative T-waves had completely disappeared 2 weeks later, likely in association with confirmed reperfusion. On the basis of prompt identification of abnormal Q-waves by electrocardiography, the patient could avoid thrombolytic therapy and catheter or surgical intervention.

Keywords: Kawasaki disease; myocardial infarction; supergiant aneurysm; transient Q-wave.

Publication types

  • Case Reports

MeSH terms

  • Anticoagulants
  • Asymptomatic Diseases
  • Coronary Angiography
  • Echocardiography
  • Electrocardiography*
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Mucocutaneous Lymph Node Syndrome / complications*
  • Mucocutaneous Lymph Node Syndrome / diagnosis
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / etiology*
  • Myocardial Infarction / therapy
  • Thrombolytic Therapy / methods*
  • Warfarin / therapeutic use*

Substances

  • Anticoagulants
  • Warfarin