Question

Case Study 1

Sample A is from a 35 year old male who visited his GP complaining of chest pain during exercise. An ECG taken at rest was normal but ischaemic changes developed on exercise. A family history revealed that his father died of a heart attack at the age of 45 years. The laboratory test results for his fasting blood sample were as follows:

Analyte                       Patient values                        Reference range for fasting

     blood sample

Sodium                                    139                              135-145 mmol/L

Potassium                                4.1                               3.0-5.0 mmol/L

Total protein                           69                                65-80 g/L

Albumin                                  35                                35-47 g/L

Calcium                                  9.3                               9.0-10.5 mg/dl

Lactate dehydrogenase           250                              90-190 IU/L

Creatine kinase                       129                              30-60 IU/L

Asparatate transaminase         70                                < 40 IU/L

Gamma glutamyl transferase 30                                < 50 IU/L

Total Bilirubin                        13                                0.4-15 μmol/L

Glucose                                   12                                3.5-5.5 mmol/L

Fructosamine                          351                              205-285 μmol/L

Cholesterol                             

            Total                            7.2                               <5.2mmol/L

            HDL                            1.4                               >1.5 mmol/L

            LDL                            ?                                  <3.5 mmol/L

Triglycerides                           2.95                             <1.7mmol/L

On the gradient gel electrophoresis, plasma sample for this patient showed the presence of small dense LDL particle.

1. Calculate and comment on the LDL cholesterol values. What does the presence of small dense LDL mean?
2. How many cardiovascular risk factors does this patient have?
3. Discuss the type of hyperlipidaemia this patient is likely to have.
4. What further tests and dietary/drug treatments would you recommend for this patient?

Answer 1

Ldl = total cholesterol- hdl - triglycerides/2.2

= 7.2- 1.4-2.95/2.2

= 5.8 - 1.35

= 4.45 mmol/l

Small dense ldl is a subtype of ldl.

Small dense has a graeter potential for formation of atherosclerosis .

It acts as a biomarker for atherosclerosis.

Cardiovascular risk factors include

Increased total cholesterol, ldl, triglycerides, glucose levels.

Decreased hdl

Risk of myocardial infarction are

Increased lactate dehydrogenase, gamma glutamic transverse, creatine kinase, aspartame transferase.

Type 2b hypercholesterolemia

( high total cholesterol, ldl, triglycerides)

Because it multifactorial and most common

Further investigation required are ecg, echo, troponin, angiography.

Drugs required are heparin ( antiplatelet) aspirin ( prevent release of thrombus)

Clopidogrel, stations, thrombolysis.

Dietary requirements are less carbohydrates, fats consumption.

High fiber content foods, high potassium salts.