Hyperlipidemia

HYPERLIPIDEMIA CHIEF COMPLAINT Hyperlipidemia HPI Symptom list • • • • • • • • • •

Ischemic vascular disease Pancreatitis Xanthomatosis Atherosclerosis Peripheral vascular disease cerebrovascular disease Hypertriglyceridemia Obesity Glucose intolerance Chest pain (angina)

Severity • • • • • • • • •

Mild Moderate Severe Absent Normal Increased Decreased Stable no significant change from prior visit

HISTORY (PMFSH) PAST HISTORY • • • • • •

Diabetes mellitus Hypothyroidism Obstructive liver disease Chronic renal failure Metabolic Syndrome Drugs

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o Progestins o Anabolic steroids o corticosteroids o anorexia nervosa o Glucocorticoids o Estrogens o Oral contraceptives o Antihypertensives Alcoholism

ALLERGY Drugs Environment FAMILY HISTORY • • • • • • •

High cholesterol levels Early coronary artery disease Heart diseases Hypertension Hypothyroidism Obesity Diabetes mellitus

SOCIAL HISTORY Habits • Alcoholism • Drugs___ • Smoking Occupation ROS PHYSICAL EXAMINATION SPECIFIC DATA LIKE GRADING ETC FREDRICKSON CLASSIFICATION TYPE I Buerger-Gruetz syndrome Primary hyperlipoproteinaemia

Familial hyperchylomicronemia TYPE II TYPE IIA Polygenic hypercholesterolaemia Familial hypercholesterolemia Type IIb Combined hyperlipidemia Type III Familial Dysbetalipoproteinemia Type IV Endogenous Hyperlipemia Type V Familial Hypertriglyceridemia TESTS TO BE ORDERED Blood tests • CBP • FBS • PLBS • RBS • Serum amylase • Cholesterol Screening o fasting total cholesterol o LDL cholesterol o high-density lipoprotein (HDL) cholesterol o triglyceride levels • Apolipoprotein B100 test • Genetic testing • Liver function tests • Renal function tests • Thyroid function tests Urinalysis o Macroscopic  Urine Bilirubin  Urine Blood  Urine Casts

 Urine Color  Urine Glucose  Urine Ketones  Urine pH  Urine Protein  Specific Gravity  Urine Urobilinogen o Microscopic  Urine WBS/hpf  Urine RBC/hpf  Urine Casts  Urine Other • Chest X-ray • ECG • 2D Echo • Angiography • CT-scan • MRI ASSESSMENT/PLAN & INSTRUCTIONS/EDUCATION • • • • • •

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Limit taking of saturated fats Increase intake of soluble fiber found in oats, peas, beans, and certain fruits Increase intake of plant stanols or sterols, found in nuts, vegetable oils, corn, and rice. Take Cold-water fish, such as mackerel, sardines, and salmon and Soy, such as tofu and soy nuts. Add or increase psyllium in diet Quite smoking Intensify weight management Increase physical activity Control hypertension Patients should restrict their dietary cholesterol intake to less than 200 mg/day. Eat foods that contain plant stanols and sterols (eg, certain margarines and salad dressings) and soluble fiber (eg, cereal grains, beans, peas, legumes, fruits, and vegetables).

MEDICATION •

Atorvastatin

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Cerivastatin Lovastatin Fluvastatin Pravastatin Simvastatin Niacin Gemfibrozil Clofibrate Fenofibrate Cholestyramine Colestipol Bezafibrate Ciprofibrate Omega-3-acid ethyl esters

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