Lipids And Cardio Part 1

The heart of the matter Digging your grave with your teeth When the heart attacks you.

Objectives: To know tests in diagnosis, prognosis and treatment, when to use, how to interpret results in: Lipid diseases. Coronary insufficiency and myocardial infarction. Congestive heart failure.

Excess lipids – the skin signs: Eruptive xanthomata Tuberous xanthomata Xanthalesma Tendons

The eye signs: Corneal arcus

Xanthelasma:

Xanthomata on tendons:

Lipoproteins: Lipoprotein and source Chylomicrons from gut VLDL from liver

Apoprotein

Function

B48, A1, CII, E B100, CII, E LDL from VLDL B100

Exogenous triglyceride Endogenous triglyceride cholesterol

HDL from liver, intestine

AI, AII

cholesterol “reverse”

Lipoprotein/Lipid disorders: Common Ischaemic heart disease – angina, myocardial infarction, (stroke) Acute pancreatitis Weakness Cataracts.

Lipid diseases Crude classification: Serum Cholesterol increased Fasting serum Triglyceride increased. Both increased when fasting. Rarer are inherited or acquired diseases where specialized lipids are abnormal

Lipid diseases, the primary laboratory tests: Serum cholesterol Serum HDL cholesterol Serum LDL cholesterol – this may be calculated, not measured. Serum triglyceride.

Serum cholesterol increased, primary: Familial combined hyperlipidaemia: LDL + VLDL increased Corneal arcus, xanthomata, vascular disease. Familial, cholesterol increased – LDL receptor lacking.

Hypercholesterolaemia, secondary: Hypothyroid, Diabetes mellitus, Nephrotic syndrome, Cholestasis, Some drugs: thiazides, insulin, beta blockers

50 year old man, non smoker, has high blood pressure: Serum cholesterol 7 mmol/L (<6) Serum triglyceride 7 mmol/L (<1.8) Serum glucose 10 mmol/L (3-5.5) Serum gamma glutamyl transferase 150 U/L (0-30) What diseases may he have? What should be done next?

Serum triglyceride, fasting, increased, primary causes: Rare Familial, serum TG and cholesterol hyperlipidaemia – serum VLDL increased Familial, endogenous hypertriglyceridaemia, liver overproduces After 40 years of age Obese Glucose intolerant Serum HDL decreased Serum uric acid increased