RSMU Class of 2008

Basically, as we all already know, high cholesterol is one of the cause of arteriosclerosis. The condition of high cholesterol is medically known as dyslipidemia. There are many form of dyslipidemia and each of them has its corresponding treatment.

Anyway, first, let us get familiar with about the different forms of lipid in our body. At least, it helps us understand what are those biochemical result actually means.

I hope that you all are aware of the share-folder located at the sidebar of this page. I am placing most of the useful guidelines from different sources: US, NICE (UK), MOH (Malaysia), Class (Russia).

I have uploaded 4 new guidelines which is the scanned/photographed version of the metodichka lent to us by teacher. Here is the direct link to download them anyway:

(1) Joint Syndrome (download)
(2) Acute Coronary Syndrome (part 1)(part2)(part3)
(3) Hypertension (download)
(4) Dyslipidemia (download)

NOTE: the PDF files are rather large in file size (since they are image files, not text-based). So, please bear with it when downloading. It should take around 3-8 mins with Strella.

I will summarize these metodichka when i have the time and put it in the blog. The PDF will be a reference material if you need more details.

Basically, as we all already know, high cholesterol is one of the cause of arteriosclerosis. The condition of high cholesterol is medically known as hyperlipidemia. There are many form of hyperlipidemia and each of them has its corresponding treatment.

What are lipids?
First, let us get familiar with the different type of lipids in our body. With this, it helps us understand what are those biochemical result actually means.

Here is the general idea. Lipids is broadly defined as any fat-soluble/hydrophobic organic molecules.
The 2 main type of lipids in our blood are:
(1) triacylglycerides -
Triacylglycerides are those we obtained from fats in our food. It’s main function is to provide energy. When in excess, it is stored mainly in adipose tissue.
(2) cholesterols -
Cholesterols are mainly synthesized by our liver. It’s main function is for cell membrane synthesis, hormone synthesis and vitamin D synthesis.

In what FORMS are lipids being transported?
The2 lipids (triacylglycerides and cholesterols) are being transported in our bloodstream in different forms.
(1) triacylglycerides are transported:
- from intestine to tissues by chylomicrons.
- from adipose tissues (depo/storage) to other tissues by VLDL (& LDL is a lesser extend)

(2) Cholesterols are transported:
- from liver (where it is synthesized) to tissues by LDL (& VLDL in a lesser extend)
# excessive cholesterol are transported back to the liver by HDL.

As we can see, LDL provide cholesterol. Where else, HDL reabsord them. That is why, high LDL and low HDL causes arteriosclerosis.

NOTE: chylomicrons, VLDL, LDL, HDL carries lipids by mean of specific apolipoproteins. Apolipoproteins are the hydrophilic parts. They bind to specific receptor of the cell membrane of our bodies tissues.

What do we get from blood biochemical test?
(1) triacylglycerides
(2) Cholesterols
(3) LDL (low density lipoproteins)
(4) HDL (high density lipoproteins)
(5) Chylomicron
(6) VLDL (very low density lipoproteins)
(7) IDL (intermediate density lipoproteins/ remnant of VLDL)

Their normal value (by European standard, 3rd revision in 2003)

Type of hyperlipidemia

WHO Classificationof hyperlipidemia

Differentiation of atrial fibrillation and ventricular fibrillation

today we learned to differentiate between artrial fibrillation and ventricular fibrillation.

Atrial fibrillation is presented as F waves (multiple P waves with irregular intervals) and in between these F waves, there can be occasional QRS complex. QRS complex should be regular form and normal duration (unless in the case of left? bundle branch block).

Ventricular fibrillation is presented as sinusoid waves (akin to sine graph). There should not be any element of standard ECG (thus, there is not PQRST). Usually the venticular contraction rate is more than 300/min.

It should be noted that ventricular fibrillation can look quite similar to ventricular tachycardia. In ventricular tachycardia, some element of standard ECG can still be found, eg: there can be R within the complex. So remember, ventricular fibrillation in ECG is presented as classical sinusoid waves.

Management for fibrillation

Ventricular fibrillation: manual CPR > DC-shock starting from 200J > CPR > 300J > CPR > 360J
Atrial fibrillation: premedication IV analgesic > DC-shock 100J > 150J

Easier Formula to Count Heart Rates

usually, we use the classical ECG formula to count heart rates
Heart Rates = 60 / (R-R small boxes * 0.04) for 25mm/s OR
Heart Rates = 60 / (R-R small boxes * 0.02) for 50mm/s

today, we got enlighten to cancel the decimals, thus receive easier formula
Heart Rates = 1500 / R-R small boxes for 25mm/s OR
Heart Rates = 3000 / R-R small boxes for 50mm/s

Correct Naming of Extrasystole

Bigemini = 1 normal : 1 extrasystole
Trigemini = 1 normal : 2 extrasystole?
Quadrigemini = 1 normal : 3 extrasystole?

Correct Placing of ECG leads

Standard lead: red = right hand, yellow = left hand, green = left leg, black/control = right leg
Chest lead: V1 =4th intercostal to the right of sternum
V2=4th intercostal to the left of sternum
V4 = apex
V3 = between V2 and V4
V5= 5th intercostal at anterior axillary line
V6 = 5th intercostal at the mid-axillary line