Secondary hyperlipidemia - Causes

From Pediatrics 2011;128:S213-S256

Causes of Secondary Hyperlipidemia

(i) Exogenous:

   Alcohol

   Drug therapy: Steroids, Isotretinoin, Beta-blockers, some OCPs, select chemotherapy agents, select anti-retroviral agents.

(ii) Endocrine/metabolic:

   Hypothyroidism/Hypopituitarism

   Type 1 and 2, DM

   Pregnancy

   Polycystic ovarian syndrome

   Lipodystrophy

   Acute intermittent porphyria

(iii) Renal:

   Chronic renal disease

   HUS

   Nephrotic syndrome

(iv) Infectious:

   Acute viral/bacterial infections

   HIV

   Hepatitis

(v) Hepatic:

   Obstructive liver disease

   Biliary cirrhosis 

   Alagile syndrome

(vi) Inflammatory diseases:

   SLE

   JRA

(vii) Storage diseases:

   Glycogen Storage disease

   Gaucher disease

   Cystine-storage disease

   Juvenile Tay-Sachs disease

   Nieman-Pick disease

(viii) Other causes:

   Kawasaki

   Anorexia nervosa

   Post-solid organ transplant

   Childhood cancer survivors

   Progeria

   Idiopathic hypercalcemia

   Klinefelter syndrome

   Werner syndrome

Lipid - Elevated Triglyceride Treatment Algorithm

From Pediatrics 2011;128:S213-S256

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Lipid - Elevated LDL treatment algorithm

From Pediatrics 2011;128:S213-S256.

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Lipid Levels - Cut-off Values

From Pediatrics;2011:128:S213-S256.

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Ectopy: Atrial vs. Ventricular?

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Atrial ectopy with aberrant conduction. Note: Small P wave is noticeable at the end of T wave preceding the ectopies.

EKG Quiz: Pacemaker

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Assuming the pacemaker is working appropriately, guess the pacemaker mode and set-rate.

Comparison of atrial rate to paced rate holds a clue to the answer.

What could be the indication for pacemaker?

What are the reasons for a 17-yr old to have this mode of pacing?

Heart Rate Variability Analysis - A primer

Link to a primer on this subject.
http://www.macses.ucsf.edu/research/allostatic/heartrate.php

Nutrition: Idaho Plate Method (CDC 2007)

Link to Idaho Plate Method from CDC:

Food Pyramid Transformation

June 2011 - ChooseMyPlate Campaign

2012 We Can campaign sponsored by NIH
(Ways to Enhance Children's Activity &Nutrition)

2010 Dietary Guidelines Link

2007 CDC - Idaho Plate Method

2005 Guidelines

DASH Eating Plan
(Dietary Approaches to Stop Hypertension) - NIH ?1999
PDF handout for parents from NIH
Standby for details on DASH...

1992 Guidelines

Physical Activity Guidelines for Americans 2008

Published by HHS.
Link to a PDF version of booklet.
Or, visit http:/www.health.gov/paguidelines

How to Read Food Labels

Learning how to read food labels is an important step, to teach patients and families.
Link to AHA website (Food label page):

Guidelines for reduction of CV risk for children

AAP Guidelines - Nov 2011. (Pediatrics 2011;128 (Suppl 5): S213). Published in print Dec 2011.
This provides guidelines for management of multiple cardiovascular risk factors in children including - Weight, Diet, Lipd disorders and Hypertension.

Cardiovascular Health and Risk Reduction in Children - NHLBI & HHS publication October 2012 (Booklet - PDF version, 89 pages).

These two guidelines are the same!

Dietary Guidelines for Americans 2010

This is an useful reference - also included guidelines from children. Click here for a PDF version
Or visit the website: www.dietaryguidelines.gov

Choose My Plate compaign (Jun 2011): http://www.choosemyplate.gov/

Nutrition: Salty Six

According to American Heart Association:
The "Salty Six"
1) Breads & Rolls (230 mg per piece)
2) Cold cuts and cured meat (1 g per pre-packaged turkey)
3) Pizza (760 mg per slice)
4) Chicken (amount depends on type of processing)
5) Soup (940 mg per cup)
6) Sandwiches (Ketchup, mustard,..) (1.5 g per sandwich)

Problem with this list is that it is not memorable! And, the items in the list are not mutually exclusive. For example, a sandwich contains breads/rolls, cold cut/cured meat or chicken. Thus, 1, 2 and 4 are actually the 6!

Angiotensin receptor blocker (ARB) in Marfan syndrome

NEJM 2008;358:2787-95.

Losartan started at 0.6 mg/kg/day x 3 weeks. Increased gradually to 1.4 mg/kg/day.
Ibesartan started at 1.4 mg/kg/day. Increased to 2.0 mg/kg/day

Link to posting about this article in Journal Club blog.

MRI Safety & Devices

Website with information regarding safety of MRI in patients with implanted devices.
http://mrisafety.com/

Incomplete Kawasaki - Algorithm

Algorithm for diagnosis of Incomplete Kawasaki Disease

(Circulation 2004;110:2747-2771)

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