Mirna Mamdouh Shaker

Background: Pulmonary embolism (PE) remains a complex clinical challenge with significant morbidity and mortality. Despite significant advancements in diagnosis and management, as well as the availability of recent guidelines, disparities in their implementation persist due to socioeconomic factors and other barriers. The study aims to assess the degree of implementation of guidelines in the diagnosis and management of PE. Results: Among 8,648 patients presenting to the National Heart Institute emergency department, 200 were diagnosed with acute PE, accounting for 2.3% of ED visits during the study period. The mean age was 56.7 ± 9.8 years, with 58% being female. Dyspnea was the most common symptom, occurring in 64% of cases, while bed rest for > 3 days was the most frequent risk factor (32%). Computed tomography pulmonary angiography (CTPA) confirmed PE in 95.5% of cases. Risk stratification classified 80% as low to intermediate-low risk, 13% as intermediate-high risk, and 6% as high-risk. Unfractionated heparin monotherapy was initiated in 63% of patients, while only 8.5% were discharged on direct oral anticoagulants (DOACs). Mortality was 3%, including 1% due to life-threatening bleeding. There was notable overuse of D-dimer testing, underutilization of ventilation–perfusion (V/Q) scans, limited prescription of DOACs, and absence of interventional therapies in eligible patients. Conclusions: This study highlights critical gaps in adherence to PE management guidelines, influenced by physician discretion, socioeconomic constraints, and diagnostic inconsistencies. Strengthening outpatient care pathways, refining risk stratification practices, and ensuring consistent guideline implementation are key priorities to optimize outcomes.

Background: The burden of premature atherosclerotic cardiovascular disease (ASCVD) in Egypt remains disproportionately high, and current international dyslipidemia guidelines have proven insufficient in achieving target lipid levels in the local population. This underscores the necessity for a context-specific national guideline. The 2025 Egyptian Guidelines for the Management of Dyslipidemia were developed through a structured consensus process led by an expert panel of cardiologists, endocrinologists, and representatives from national medical societies. Main text: The methodology included two rounds of blind voting followed by a consensus meeting to ensure rigorous evaluation. The guidelines emphasize the importance of early detection of dyslipidemia through systematic screening programs and prioritize lifestyle interventions as the cornerstone of management. A novel “extreme-risk” category was introduced to identify patients requiring intensified lipid-lowering strategies, including early initiation of combination pharmacotherapy. Additionally, the recommendations highlight the critical role of ongoing monitoring and follow-up to sustain long-term lipid control and reduce cardiovascular risk. Conclusion: The current guidelines provide a simplified, yet evidence-based framework tailored to the Egyptian population, aiming to optimize dyslipidemia management, reduce ASCVD-related complications, and improve overall cardiovascular outcomes.

Dual antiplatelet therapy with aspirin and a thienopyridine is used to prevent thrombotic complications of acute coronary syndrome (ACS) and percutaneous coronary interventions (PCI). Ticagrelor is an oral, reversible inhibitor of the adenosine diphosphate receptor P2Y12 with a faster onset and more potent platelet inhibition than clopidogrel. A study was needed to evaluate the efficacy and safety of generic ticagrelor in Egyptian patients. This multicenter study included 830 patients aged above 40 years and diagnosed with ACS, with or without ST segment elevation during the preceding 6 months. They received generic ticagrelor (Thrombolinta, Global Napi Pharmaceutical Company, Egypt) (180 mg loading dose, 90 mg twice daily thereafter), added to aspirin 75–100 mg daily. The mean age of our study population was 57.5 (8.3) years and 38.3% were females. Hypertension, diabetes mellitus, dyslipidemia and previous coronary revascularization were present in 70.7%, 59.2%, 80.7% and 31% of the patients, respectively, and 42.5% were current smokers. The qualifying event was unstable angina, non-ST segment elevation myocardial infarction and ST segment elevation myocardial infarction in 54%, 21.8% and 24.2% of the patients, respectively. At 6 months, the primary efficacy end point—a composite of cardiovascular death, myocardial infarction and stroke—occurred in 3.4% of patients, while the secondary efficacy endpoint—a composite of the primary efficacy endpoints with the addition of hospitalization for unstable angina and urgent revascularization—occurred in 15.3%. Cardiovascular death occurred in 1.2% of the patients, myocardial infarction in 0.8%, stroke in 1.3%, hospitalization for UA in 8.1% and urgent revascularization in 3.9%. TIMI major bleeding occurred in 1.2% of patients, intracranial hemorrhage in 0.2% and TIMI minor bleeding in 13.3%. No significant difference was found between patients who underwent PCI at baseline and those who were treated conservatively regarding the primary (14 patients in each group, P = 0.931) and secondary (62 vs. 65 patients, P = 0.946) efficacy endpoints. In patients who had an ACS during the 6 months preceding enrollment, treatment with generic ticagrelor led to a low rate of cardiovascular death, myocardial infarction and stroke with a minor increase in the risk of major bleeding.

Hypertriglyceridemia (HTG) is a very common, yet underappreciated problem in clinical practice. Elevated triglyceride (TG) levels are independently associated with atherosclerotic cardiovascular disease (ASCVD) risk. Furthermore, severe HTG may lead to acute pancreatitis. Although LDL-guided statin therapy has improved ASCVD outcomes, residual risk remains. Recent trials have demonstrated that management of high TG levels, in patients already on statin therapy, reduces the rate of major vascular events. Few guidelines were issued, providing important recommendations for HTG management strategies. The goal of treatment is to reduce the risk of ASCVD and acute pancreatitis. The management stands on lifestyle modification, detection of secondary causes of HTG and pharmacological therapy, when indicated. In this guidance we review the causes and classification of HTG and summarize the current methods for risk estimation, diagnosis and treatment. The present guidance provides a focused update on the management of HTG, outlined in a simple user-friendly format, with an emphasis on the latest available data.

Background: Myocardial reperfusion may cause profound electrophysiological alterations and can lead to serious reperfusion arrhythmias (RA). Management of RA and the accompanying electrical storm that may occur remains a problem. To our knowledge, the role of balloon re-inflation of the infarct-related artery (IRA) has never been addressed as a treatment modality for RA presenting as ventricular tachycardia (VT) with pulse or supraventricular tachycardia (SVT). Case presentation: Six patients presenting with ST elevation myocardial infarction (STEMI) in the first 12 h, who underwent successful primary percutaneous coronary intervention (PCI), developed RA in the cathlab after restoration of flow in the IRA. The RA was in the form of VT with pulse, except in one patient who had SVT. In four patients, the RA was associated with hemodynamic instability. The mean age of the studied patients was 59.16 ± 7.94 years, and four were males. Coronary artery disease risk factors were prevalent, with four patients being hypertensive, two dyslipidemic, one diabetic, and 2 current smokers. One patient had a history of prior myocardial infarction (MI), and none had a history of congestive heart failure. The coronary angiography showed 100% occlusion of IRA in all patients and 2–3-vessel disease was present in 50%. PCI was successful with restoration of thrombolysis in myocardial infarction (TIMI) 2–3 flow in IRA in all cases. The mean time to revascularization from the onset of chest pain was 4.88 ± 2.68 h. In all cases, balloon re-inflation was successful in terminating the arrhythmias. None of the patients needed direct current cardioversion or anti-arrhythmic drugs for management of the acute arrhythmia. Conclusion: Balloon re-inflation of IRA was successful in terminating RA that develop in the form of VT with pulse or SVT.

Background: Numerous epidemiological investigations and randomized clinical studies have determined that dyslipidemia is a major contributor to atherosclerotic cardiovascular disease (ASCVD). Consequently, the management of serum cholesterol and low-density lipoprotein levels has become a central objective in the effort to prevent cardiovascular events. Main body: Many guidelines were issued by different organizations and societies to define patient risk and establish important recommendations for management strategies. Newer cholesterol-lowering agents (non-statin drugs) are described, and their use is directed primarily to secondary prevention in patients at very high risk of new ASCVD. Conclusion: The present guidance summarizes the current methods for risk estimation and outlines the most recent data on lipid management in a simple user-friendly format, to improve physician awareness and help implement guidelines in the daily practice.

Background: The COVID-19 pandemic poses a major burden to the healthcare system in Egypt, and in the face of a highly infective disease which can prove fatal, healthcare systems need to change their management protocols to meet these new challenges. Main body: This scientific statement, developed by the cardiology department at Cairo University, emphasized 6 different aspects that are intended to guide healthcare providers during cardiopulmonary resuscitation (CPR) in the era of the COVID-19 pandemic. It highlighted the importance of dealing with all cardiac arrest victims, during the pandemic, as potential COVID-19 cases, and the use of appropriate personal protective equipment (PPE) by health care providers during the procedure. It also stated that the CPR procedure should be done in a separate room with the door closed and that the number of providers present during the procedure should be limited to only those who are essential for patient resuscitation. It also stressed that family members and accompanying personnel of patients with possible COVID-19 should not be in the vicinity of CPR site. The statement also pointed out that CPR procedure should be done in the standard manner with precautions to minimize spread of infection to the staff and accompanying people. Early intubation was prioritized, and the use of rapid sequence intubation with appropriate PPE was recommended. For delivery of CPR for the prone ventilated patient, delivery of chest compressions by pressing the patient’s back, while a team prepares to turn the patient supine, was recommended. During intra-hospital transport, it was emphasized that the receiving intensive care unit (ICU) should be notified about the possibility of the patient being COVID-19 positive, so that appropriate infection control precautions are taken. Conclusion: Cardiopulmonary resuscitation of cardiac arrest patients in the COVID-19 era poses a significant challenge, and all health care providers should deal with any cardiac arrest victim presenting to the emergency department as potential COVID-19 suspects and should use the appropriate PPE.