Coronavirus disease-2019 (COVID-19) is a novel disease that has become a global health problem with high mortality rates. Up to now, there is neither specific treatment nor a vaccine for the disease; hence, the primary goal is to keep patients alive. There is growing evidence that more men than women are dying from the COVID-19. Although the outbreak of COVID-19 has led to the legislation of exceptional public health measures in various countries, fatality difference among genders has not been changed in favor of women. It is important to understand the role of sex to figure out who is most vulnerable to COVID-19 and the risk factors of death. While the precise mechanism of globally observed lower female death rates is still unknown, there are many speculations such as the effect of X chromosome, immunologic distinction, lifestyle choices, and employment status. The aim of this review is to highlight the most relevant connections between COVID-19 and low mortality rate in women globally.

Background: Previous studies have shown the relationship between respiratory viruses with acute coronary syndromes. However, its relationship with a new virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is not clear yet. Aim: Our aim is to investigate the frequency of ST-segment elevation myocardial infarctions (STEMIs) presenting to catheterization laboratories during SARS-CoV-2 pandemic. Methods: As a pilot study, the number of patients with a primary diagnosis of STEMI admitted to the catheterization laboratory with the purpose of primary percutaneous coronary intervention (PCI) between March 15 and April 15, 2020, also known as the 1^st month of the pandemic, was determined. This number then has been compared to the same period of 2019 (March 15, 2019, to April 15, 2019). Results: During the pandemic period (March 15, 2020, to April 15, 2020), eight cases were admitted to the catheterization laboratory for primary PCI, due to STEMI. It was determined that 32 patients were admitted to the catheterization laboratory in the same period of 2019 (March 15, 2019, to April 15, 2019). When primary PCI numbers were compared, it was found that there was a 75% decrease in the number of cases. In 2019, the monthly average of STEMI cases was 25 ± 8. Compared to 2019, there was a 65% reduction. Conclusion: We found that, there was a substantial decrease in STEMI cases during pandemic period, at least in the initial phase.

Background: Transulnar approach (TUA) was comparable to the transradial approach (TRA) in terms of efficacy and safety in the presence of extensive operator experience in the TUA. Without adequate experience, there was an increase in time, and number of punctures, to successful access. Objectives: The aim of the study was to compare the in-hospital safety of duplex ultrasound (DUS) assisted TUA to those of DUS-assisted TRA. Methods: All patients had preprocedural DUS assessment. Patients who needed urgent procedures (e.g., ST-elevation myocardial infarction) or had a history of upper extremity arterial disease were excluded. The patients were randomized into TUA or TRA arms. The primary endpoint was a composite of in-hospital vascular access complications (bleeding, limb ischemia, local pain, spasm, and need for crossover). The timing to successful puncture, total number of punctures, total procedural time, fluoroscopy time, amount of contrast, and radiation dose were compared between the two arms as well. Results: A total of 104 patients were randomized into TUA (n = 50) or TRA (n = 54) arms. There was no statistically significant difference between both arms in terms of the primary endpoint (TUA vs. TRA: 37.5% vs. 28.6% respectively, P = 0.33). Apart from an increase in the incidence of access site pain (28% vs. 7%, respectively, P = 0.006), there was no statistically significant difference between the two approaches in terms of time to successful access, number of punctures, total procedural time, fluoroscopy time, or contrast and radiation doses. There was no clinically detectable limb ischemia in both arms on 30-day follow-up. Conclusions: This study demonstrated that there was no difference in safety between DUS-assisted TRA and TUA. In the presence of DUS, TUA becomes a viable alternative arterial access even with the lack of previous TUA experience. More prolonged follow-up is needed to exclude late subclinical events related to the TUA.

Objective: The prognostic impact of worsening renal function (WRF) in patients with acute decompensated heart failure (ADHF) with preserved ejection fraction is controversial, and the pathophysiological mechanisms of WRF are not clearly understood. Methods: Fifty-three patients with ADHF with preserved ejection fraction were analyzed. WRF was defined as an increase of ≥ 0.3 mg/dL in the serum creatinine level during the first 5 days of the hospitalization and occurred in 37.7% of the study population. Results: Although baseline C-reactive protein (CRP) levels on admission was similar between patients with and without WRF, patients with WRF had higher 48-h CRP and delta CRP (Δ−CRP = 48-h CRP value − baseline CRP value) levels than those of patients without WRF. Multivariable analysis revealed that the baseline creatinine level and Δ−CRP were the independent risk factors for the development of WRF. The length of hospital stay (LOS) was significantly longer in the WRF group (9.9 ± 10.2 vs. 5.4 ± 2.8 days; P = 0.020). The median follow-up of the study population was 683 days, and the all-cause mortality rate was higher in patients with WRF than those without WRF (40% vs. 9.1%, P = 0.007, respectively). Conclusion: Baseline creatinine levels and Δ−CRP were the independent predictors of WRF. Increased inflammatory status expressed by Δ−CRP is found to be a novel finding for predicting the development of WRF in patients with ADHF with preserved ejection fraction. The presence of WRF was found to be associated with a poorer prognosis, including longer LOS, higher all-cause in-hospital, and all-cause postdischarge mortality.

Introduction: The aim was to study the clinical, social, biochemical, and angiographic profile of premature coronary artery disease (PCAD) in young smokers. Subjects and Methods: The PCAD registry has 3450 patients till date, of which 1985 (57.53%) patients fulfilled the entry criteria: tobacco smokers. The entire clinical data, biochemical parameters, and angiographic profiles of these patients were documented. The data were analyzed by statistical software R version 3.5.0. Results: The study enrolled 1985 patients after satisfying the entry criteria. The mean age of this study group was 33.97 years, with 100% male population. A total of 140 (7.05%) patients had diabetes mellitus, 246 (12.39%) had hypertension, and 269 (13.55%) patients had a strong family history of PCAD. Majority of them (1415 [71.28%]) had abdominal obesity; polycythemia was seen in 738 (37.17%) patients. One thousand three hundred and three (65.06%) patients had low high-density lipoprotein (HDL) cholesterol, 293 (14.76%) patients had elevated low-density lipoprotein (LDL) cholesterol, and 656 patients (33.04%) had elevated triglycerides. The most common index presentation of coronary artery disease (CAD) in these patients was ST elevation myocardial infarction (STEMI) seen in 1583 (79.74%) patients. One thousand six hundred and eighty-nine (85.08%) patients underwent coronary angiography, of which 999 patients (59.16%) had recanalized/normal/nonobstructive coronary arteries. Six hundred and ninety-five patients (41.14%) had significant CAD, of which 77 patients (4.55%) particularly had high thrombus containing lesions. Ultimately, 1441 (71.08%) were treated only with optimal medical therapy. Five hundred and thirty-six patients (27.01%) underwent revascularization in the form of angioplasty (515 patients) and coronary artery bypass surgery (21 patients). Conclusions: Common presentation of PCAD in young smokers was acute coronary syndromes predominantly as STEMI. Polycythemia and other conventional risk factors such as low HDL cholesterol levels, elevated LDL cholesterol levels, and abdominal obesity are also seen commonly in this subgroup.

Background: Cancer and cardiovascular diseases are prevalent worldwide, especially in the developed world. Chemotherapeutic agents can cause short- and long-term cardiotoxic effects ranging from asymptomatic and transient to clinically significant and long-lasting cardiac events. Using of left ventricular ejection fraction (LVEF) is considered the most important component in the prediction and detection of cardiotoxicity caused by chemotherapy. The drop in LVEF occurs mostly in the last stages, and hence, it is not sensitive in picking early cardiac toxicity. A reduction in global longitudinal strain (GLS) by speckle tracking echocardiography (STE) is proposed to be the earliest indicator of myocardial dysfunction. This study aimed to assess the role of STE and three-dimensional (3D) EF in early detection of cardiotoxicity in patients receiving cardio-toxic chemotherapy. Materials and Methods: This is a cohort prospective study that was carried out in Benha University Hospitals were 99 patients with different malignancies on different chemotherapeutic regimens were recruited aiming to evaluate the role of 3D echocardiography in early detection of cardiotoxicity of chemotherapy, thorough history, examination, and 3D echocardiography was done. Results: In this study, 99 patients were included, with mean of age was 55 years, 30.3% of patients were males and 66.7% of patients were female. The median two-dimensional EF was 67.3%, which decreased to 63.0% at 3 m follow-up. While 3D EF was 60.25%, which decreased to 56.0% at 3 m follow-up. GLS was − 22.5 at 0 m and − 20.4 at 3 m follow-up. GLS reduction ≥−8.9% at 3 months follow-up correlated with decreased 3D EF% <53% with 86.7% sensitivity and 58% specificity. Conclusion: in patients receiving cardiotoxic chemotherapy, the reduction in GLS preceded the decrease in EF. Hence, the early detection of this reduction could help to modify chemotherapeutic regimens to avoid irreversible cardiac damage.

Obstructive mechanical valve thrombosis is a rare and serious disease. Despite therapeutic progress, mortality remains high, and the choice between surgery and thrombolytic therapy remains controversial. We report the case of a 46-year-old woman admitted to the emergency department for obstructive mitral mechanical valve thrombosis successfully thrombolyzed by the recombinant tissue plasminogen activator. Through this case, we would like to discuss the different therapeutic options, and why fibrinolysis was our choice for this particular patient.

Focal atrial tachycardia arising from the left atrial appendage (LAA) is less frequently encountered in clinical practice. Catheter ablation of this focal tachycardia is the main treatment and has a high success rate. Surgical radiofrequency isolation plus external closure of the appendage is an option in patients' refractory to catheter methods. An 18-year-old male patient was admitted to our hospital with a diagnosis of tachycardia-induced cardiomyopathy (ejection fraction 35%). His electrophysiological study revealed a centrifugal activation pattern in the LAA where local atrial activation was earliest. Sinus rhythm was not achieved despite multiple attempts. Surgery was planned to isolate the source of the refractory arrhythmia. LAA of the patient was electrically isolated by using AtriCure^® Synergy Ablation Clamp through the left anterior mini-thoracotomy. Sinus rhythm was restored right after successful isolation. AtriClip^® PRO device was used to externally exclude the LAA to eliminate possible thrombus formation in isolated appendage. Surgical ablation methods are valid and successful options in patients who are refractory to medical and catheter methods. Dedicated arrhythmia teams (cardiologists, electrophysiologists, and cardiac surgeons) have the potential to increase patients' outcomes.

Contrast-induced encephalopathy (CIE) is a rare temporary phenomenon after intravenous injection of contrast media. The prognosis is generally good. Neurological symptoms develop within hours and resolve spontaneously over days. Global syndromes such as confusion can also be seen with cortical and subcortical deficits. There is a good correlation between the volume of contrast extravasation and clinical picture. In addition, this extravasation can be confused with intracranial hemorrhage in the early stage with imaging. In this case, we presented a 62-year-old male patient who developed CIE after coronary angioplasty mimicking subarachnoid hemorrhage and spontaneously recovered on the 2^nd day of the event.

Visceral artery aneurysms can be life-threatening conditions with a high incidence of rupture. The endovascular technique with coil embolization is successful procedure for aneurysm treatment. Herein, we presented a case with a new and inexpensive treatment of splenic artery aneurysm by a coronary bare metal stent.