Monday, June 9, 2014

What is LDL Apheresis ?

Patients with homozygous familial hyperlipidemia are deficient in LDL receptors , and measures that rduce cholesterol absorption ( e.g., diet , ileal exclusion , bile acid sequestrans , and ezetimibe ) or act by LDL receptor upregulation ( e.g., statin) are largely ineffective . these patients are treated with LDL apheresis and should be managed in tertiary care centers only .

-LDL Apheresis is a FDA-approved process of selectively removing Apo B-containing particles from the circulation through extracorporeal precipitation with either dextran sulphate cellulose or heparin . 

-The procedure must be repeated every 1 to 2 weeks  

-In a single procedure , LDL ahperesis typically removes at least 60% of the Apo B-containing lipoproteins .

 Apheresis will have to be conducted at least once every 1 to 2 weeks, because LDL cholesterol levels rebound to pretreatment levels within about 12 to13 days after apheresis. A single LDL apheresis procedure can remove up to 68% to 80% of LDL cholesterol and also lower LP(a) by about 50%; an additional result of both of these reductions is to lower fibrinogen. Apheresis also reduces inflammatory markers, such as CRP, LpPLA2, adhesion molecules, etc.

Sunday, June 8, 2014

Clinical significance of PVCs

-   Clinical significance of PVCs depends on the clinical context in which they occur.
- PVCs in young healthy patients without underlying structural heart disease are usually not associated with any increased rate of mortality.
-     PVCs in older patients, especially with underlying heart disease, are associated with an increased risk of adverse cardiac events, esp sustained ventricular dysrhythmias and sudden death.