QR in V1 – an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism

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.

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.

Hypertrophic Cardiomyopathy Vs. LVH