Sandbox:lipid
| Lipid disorders | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypolipoproteinemia | Hyperlipoproteinemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Primary | Secondary | Primary | Secondary | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Low LDL | Low HDL | Anemia, Chronic inflammation, Chronic liver disease, Hyperthyroidism Infection, Malabsorption, Malignancy, Criticial illness | Alcohol, Diabetes, Drugs Liver disease, Obesity Renal disease Smoking, Hypothyroidism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Abetalipoproteinemia, Hypobetalipoproteinemia PCSK9 deficiency, Chylomicron retention disease, Familial combined hypolipidemia | LCAT deficiency, Apolipoprotein 1 deficiency, Familial hypoalphalipoproteinemia, Tangier disease, FISH eye disease, Familial combined hypolipidemia | Type I: Familial hyperchylomicronemia | Type II | Type III: Dysbetalipoproteinemia | Type IV: Primary hypertriglyceridemia | Type V: Mixed hyperlipoproteinemia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Type A: Familial hypercholesterolemia | Type B: Familial combined hyperlipidemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Functional Asseeement | ||
|---|---|---|
| Key Steps | Essential Elements | Additional Details |
| Frailty and Disability | Symptoms
AS severity |
Intensity, acuity
Echo and other imaging |
| Baseline clinical data | Cardiac history
Physical exam and labs Chest irradiation Dental evaluation Allergies Social support |
Prior cardiac interventions
Routine blood tests, PFTs Access issues, other cardiac effects Treat dental issues before TAVR Recovery, transportation, post discharge planning |
| Major CV comorbidity | Coronary artery disease | Coronary angiography |
| LV systolic dysfunction | LV ejection fraction | |
| Concurrent valve disease | Severe MR or MS | |
| Pulmonary hypertension | Assess pulmonary pressures | |
| Aortic disease | Porcelain aorta (CT scan) | |
| Peripheral vascular disease | Prohibitive re-entry after previous open heart
surgery (CT scan) Hostile chest
| |
| Major non CV comorbidity | Malignancy | Remote or active, life expectancy |
| Gastrointestinal and liver disease | IBD, cirrhosis, varices, GIB, ability to take
antiplatelets/anticoagulation | |
| Kidney disease | eGFR <30cc/min or dialysis | |
| Pulmonary disease | Oxygen requirement, FEV1 <50% predicted or
DLCO<50% predicted | |
| Neurological disorders | Movement disorders, dementia | |
| Functional Asseeement | ||
|---|---|---|
| Key Steps | Essential Elements | Additional Details |
| Frailty and Disability | Frailty Assessment | Gait Speed (<0.5m/sec or < 0.83 m/sec with
disability/cognitive impairment) Frailty (Not Frail or Frail by Assessments) |
| Nutritional Risk/Status | Nutritional Risk Status (BMI<21, albumin
<3.5mg/dl, >10-pound weight loss in past year, or ≤11 on MNA) | |
| Physical Function | Physical function and endurance
Independent living |
6-minute walk <50 m or unable to walk
Dependent in>=1 activities |
| Cognitive Function | Cognitive Impairment
Depression and Prior Disabling Stroke |
MMSE <24 or dementia
Depression history or positive screen |
| Futility | Life expectancy
Lag-time to benefit |
<1 year life expectancy
Survival with benefit of <25% at 2 years |