A Harnden

Rising incidence of Kawasaki disease in England: analysis of hospital admission data.

Kawasaki disease is the leading cause of acquired heart disease in children in the developed world and may be a risk factor for adult ischaemic heart disease.1 A fifth of untreated children develop cardiac lesions during the acute phase of the disease. The cause remains uncertain. Epidemiological studies support an infectious agent inducing the disease in a genetically susceptible minority. Superantigen toxins have been implicated. Reported incidence rates differ considerably throughout the developed world with rates in Japan 10 times those in the United States and 30 times those in the United Kingdom and Australia.2–4 Hospital surveillance data suggest the incidence of Kawasaki disease in Japan has risen by over 50% between 1987 and 1998.2 To ascertain whether there had been a similar rise in England, we …

Coarctation of the aorta in the newborn

#### Key pointsnnA 14 day old infant presented with poor feeding, sleepiness, and loss of weight. He was born at term with normal vaginal delivery and was discharged within 24 hours after a newborn check was normal. Examination showed mild tachycardia, tachypnoea, weak femoral pulses, and a soft systolic murmur at the left sternal edge. The lungs were clear and the liver was enlarged by 3 cm. He was immediately referred to a specialist paediatric cardiology centre, where, after further investigation, a diagnosis of coarctation of the aorta was confirmed, prostaglandin was started, and the patient had successful surgical correction. nnCongenital heart disease is the commonest group of congenital diseases. It affects 19 in 1000 live births worldwide1 and accounts for 9% of infant deaths in the United Kingdom.2 Coarctation of the aorta is a discrete narrowing of the proximal descending aorta and accounts for 7% of congenital heart defects (figs 1 to 3⇓ ⇓ ⇓).1 3 nnnnTop: Normal heart. Bottom: Heart with coarctation of the aorta (arrows indicate direction of all blood flow)nnnnnnCoarctation of the aorta is a narrowing of the aorta, the major artery leading from the heart to the body. Blood pressure …

New primary care series: Easily Missed?

The series advisers of this new series explain why heightened awareness is needed of conditions that may be commoner than many doctors realise or may be missed at first presentation