Hyperlipidemia diagnosis

Lipoprotein disorders are detected by measuring lipids in serum after a 10-hour fast. Risk of heart disease increases with concentrations of the atherogenic lipoproteins, is inversely related to levels of HDL, and is modified by other risk factors (Table 35-1). Evidence from clinical trials suggests that LDL cholesterol levels of 60 mg/dL may be optimal for patients with coronary disease. Ideally, triglycerides should be below 120 mg/dL. Differentiation of the disorders requires identification of the lipoproteins involved (Table 35-2). Diagnosis of a primary disorder usually requires further clinical and genetic data as well as ruling out secondary hyperlipidemias (Table 35-3). 

Diagnosis of nephrotic syndrome depends on the identification of both the clinical signs (edema) and laboratory disorders (proteinuria, hypoproteinemia, hypoal-buminemia, hyperlipidemia). Lipid and coagulation abnormalities that also must be monitored are described in detail in the appropriate sections. 

Diagnosis of the Type III Lipoprotein Pattern. The ratio of VLDL cholesterol to plasma triglyceride, expressed in terms of mass, is 0.2 or lower in normal samples and in those from patients with lipoprotein disorders other than type III hyperlipidemia. In type III hyperlipoproteinemia, the ratio is 0.3 or higher because of the presence of p-VLDL, and the elevated ratio can persist even after treatment. 

Joint statement for physicians by the Committee on Atherosclerosis and Hypertension in Childhood of the Council on Cardiovascular Disease in the Young and the Nutrition Committee, American Heart Association Diagnosis and treatment of primary hyperlipidemia in childhood. Circulation 1986 74 1181-A. 

As with any good medical encounter, a detailed patient history of symptoms and atherosclerosis risk factors (e.g., smoking, hypertension, hyperlipidemia, and diabetes) can be helpful in the diagnosis of PAD. Unfortunately, as illustrated by the PARTNERS program, providers who rely on a history alone will miss approximately 85% to 90% of patients with PAD. Therefore, examination of the patient is vital to proper diagnosis. Requesting that the patient remove socks and shoes may reveal nonspecific signs of decreased blood flow to the extremities (i.e. cool skin temperature, shiny skin, thickened toenails, lack of hair on the calf, feet and/or toes) or, in severe cases, visible sores or ulcers that are slow to heal and may even be black in appearance. - ... 

Type II Hyperlipidemia, The Merck Manual of Diagnosis and Therapy. http //www.merck.com/mrkshared/mmanual/section2/chapterl5/15c.jsp, 2004. 

Three examples of the clinical applications are presented alteration of lipoprotein distribution for a patient with acute hepatitis according to recovery of disease (Fig. 23), change of HDL subfractions for a patient with coronary heart disease by a drug therapy (Fig. 24), and diagnosis of the type for hyperlipidemia by HPLC patterns (Fig. 25). 

IV and V) according to the definition by Fredrickson et al. (40). The elution patterns of three lipid components using the G5000PW+G5000PW column system present the characteristic feature for each type as shown in Fig. 25. Thus, these HPLC patterns obtained from whole serum in our lipid monitoring technique are very useful for diagnosis of the type for hyperlipidemia. 

Meperidine is thought to inhibit both the 5-HT2A receptors and norepinephrine (NE) reuptake mechanism which may precipitate a serotonin syndrome, a toxic state secondary to excessive serotonin ago-nism of the CNS [3,4]. This adverse drug reaction occurs most commonly in patients who are using single or multiple medications that increase postsy-naptic serotonin levels. Inherited deficiencies in the metabolism of serotonin may contribute to the development of the syndrome. Hypertension, atherosclerosis, and hyperlipidemia are all associated with a reduction in endothelial MAO activity and thus a reduced capacity to metabolize serotonin may increase the risk of a serotonin crisis. The diagnosis... 

A very common disorder frequently associated with elevated VLDL and LDL or elevated VLDL only is termed familial combined hyperlipidemia (FCHL) (Table VIII). In order to make a diagnosis, the family of the patient must be screened. Some family members will display increases in VLDL, others in LDL, and some in both VLDL and... 

---