Investigations
|
|
For Dyslipidemic Patients With Or Without Associated Illnesses Like Hypertension, Diabetes, Hypothyroidism, Stroke, Ischemic Heart Disease, Obesity. |
Aim of investigations
|
|
To establish or rule out Lipid abnormalities in a patient belonging to high risk group including -Genetic predisposition (tendencies to run in families), Diabetes, Obesity, Sedentary life styles, Fatty food consumption, Hypothyroidism (deficiency state of thyroid gland), Hyperhomocystinemia (increased levels of homocystine levels in blood), Smoking and Alcohol intake. |
|
|
As a part of routine checkup especially after 35 years of age and much earlier in high risk group to detect lipid abnormalities to prevent and reverse further risks and complications. |
|
|
To assess 'Target Organ Damage' due to Lipid abnormalities. (damage to organs and body systems due to undiagnosed /untreated / Dyslipidemia. |
|
|
To detect coexisting illnesses like Diabetes, Heart diseases, Hypothyroidism (deficiency state of thyroid gland), Hyperhomocystinemia (increased levels of homocystine levels in blood) which have links with Dyslipidemia. |
|
|
To monitor and compare results ; Pre and post treatment . |
Limitations of treatment without proper investigations
|
|
'Superficial treatment' of associated medical illnesses without proper investigations, may overlook Dyslipidemia which is an important risk factor. |
|
|
Such half hearted treatment may apparently give short term results, in form of blood pressure/Diabetes control, but will fail to prevent, delay and treat complications like angina, heart attacks, stroke, kidney failure, eye damage, nerve damage due to progressive damage and clogging of arteries of various organ systems due to Dyslipidemia. |
|
|
It will thus neither increase life expectancy nor quality of life. |
|
|
In patients in high risk groups and in apparently healthy individuals, there are often no symptoms of Dyslipidemia and this can only be assessed by blood tests. |
Management of Dyslipidemia includes
|
|
Choosing most appropriate Lipid lowering drug based on investigations (pattern of lipid abnormalities) and clinical examination. |
|
|
Controlling risk factors, detected on investigations like: , excess salts in blood. |
|
|
Vigorous treatment of any 'Target Organ Damage'. detected on investigations. |
|
|
Treatment of coexisting illnesses like Diabetes, Heart diseases, etc. |
Investigations for initial assessment in a patient of Lipid Disorders
|
|
Lipid Profile (Total Cholesterol, LDL Cholesterol, VLDL Cholesterol, HDL Cholesterol, Triglycerides) |
|
|
Serum Electrolytes (Sodium, Potassium, Chloride, Bicarbonate) |
|
|
Kidney Function Tests. Blood Urea, Serum Creatinine, Serum Uric Acid, Blood Urea Nitrogen ) |
|
|
Blood Sugar Fasting, Post Prandial (P.P) |
|
|
Urine Routine / Microscopic; Microalbumin (sign of early kidney damage) |
|
|
Serum Homocysteine Levels. |
|
|
ECG Electrocardiograph (ECG), a device used to record the electric activity of the heart to detect abnormal electric impulses through the muscle. Electrocardiography allows diagnosis of cardiac abnormalities. To make an ECG recording, the patient lies quietly on his or her back on a table. Leads are placed on certain spots on the patient's chest, usually with a gluey gel that helps send the electric impulse to the recording device. The ECG is also used for stress tests, which require that the patient be active (usually walking or running on a treadmill) while the machine is working |
Miscellaneous
Hb, TLC, DLC, ESR
Thyroid Profile ( Whenever indicated)
TMT (Tread Mill Test)
TMT (Tread Mill Test)
|
|
Exercise electrocardiogram (exercise ECG), a stress test used to diagnose disease of the arteries of the heart. An exercise electrocardiogram is recorded while a person walks on a treadmill or pedals a stationary bicycle. Abnormal changes in heart function may appear during exercise. Some abnormalities will not show on ECG during rest. |
Angiography
|
|
Angiography, the x-ray study of the inside of the heart and blood vessels. It is done after a dye is injected. It is used to test for heart attacks (myocardial infarction), blocked vessels (vascular occlusion), hardened deposits in the arteries, stroke, high blood pressure, kidney tumors, lung clots, and lung vessel problems. |
Echocardiography.
|
|
Also called ultrasonic cardiography. A method of diagnosis that studies the structure and motion of the heart. Ultrasonic waves directed through the heart are reflected backward, or echoed, when they pass from one type of tissue to another, as from heart muscle to blood. This test can find tumors in the upper chambers and fluid in the sac around the heart (pericardial effusion). It can measure the parts of the lower chambers (ventricles) and spot problems with the movement of the valve between the upper and lower chambers on the left side of the heart (Mitral valve). |
Echocardiography. Echocardiography ECG
CAT Scanning Angiography
More specialized investigations should generally be reserved for those dyslipidemic and hypertensive patients who fulfill the following criteria:
-
Below 45 years of age.
-
Blood pressure resistant to the combination of two drugs.
-
Severe hypertension , that is, diastolic blood pressure > or = 120 mmHg.
-
Suspicion of a cause or complication of Hypertension from clinical assessment or routine investigations.
-
Those with retinopathic findings of revised grading system - grade B.
Patients whose hypertension is very severe, or who are resistant to conventional treatment, need further specialist investigation. These tests include:
|
|
Radiography of abdomen. |
|
|
Ultrasound of kidneys. |
|
|
Intravenous urography or renal Arteriography to exclude renal artery stenosis. |
|
|
CAT ( Computerized Axial Tomography ) Scanning of the adrenal gland. |
|
|
24 hours urine specimens should be collected on three separate occasions for assessment of catecholamine excretion, urinary protein excretion or 24 hour urinary free cortisol estimation. |
|
|
Renal biopsy may be appropriate to identify a cause of renal impairment, particularly if intrinsic renal disease (for example, (Glomerulonephritis) is suspected. |