The Egyptian Cardiac Rhythm Association

The pathophysiology of atherosclerosis was also extensively discussed. Metabolic imbalance and high levels of harmful fats (cholesterol and triglycerides) circulating in the blood vessels play a major role in atherosclerosis, especially in diabetic patients. The large fat molecules precipitate on the wall of the blood vessels of the heart, kidneys, limbs and cerebral arteries. Macrophages attack and swallow these molecules, but fail to degrade them. In turn, these macrophages deposit on the vessel wall as fatty “foam cells”. With time, the vessel wall progressively weakens by the foam cells and becomes prone to calcium deposition, especially in hypertensive patients. This process results in the narrowing of the arterial lumen with the subsequent decrease of blood flow to the organ. Chest pain with exertion “angina” is an alarming symptom of atherosclerotic CAD which is caused by insufficient coronary blood flow to suffice the heart oxygen demand. If this weakened “unstable” vessel wall cracks, it leads to the activation of the blood clotting cascade with the formation of a blood clot obstructing the lumen of the artery and leading to a “myocardial infarction”. Early revascularization (with balloon angioplasty and stenting) is life saving in the first hours of myocardial infarction. If early revascularization within 12 hours was not possible, part of the heart muscle will die and become fibrotic leading to heart muscle loss and heart failure. Therefore, it is paramount to raise public awareness on the prevention of atherosclerosis and coronary artery disease and on the early management of acute coronary syndromes.

As mentioned before, diabetes leads to fat deposition in the arterial wall and atherosclerosis. The intensity, composition and the degree of instability of the atherosclerotic plaque determine the incidence of unstable angina and myocardial infarction. Therefore, the European and American guidelines recommend cholesterol blood level of less than 100 mg and less than 70 mg for patients with established coronary artery disease. The guidelines also emphasize on the importance of exercising for 30 minutes a day and eating a diet rich in fruits and vegetables for the prevention of Coronary Heart Disease. Intriguingly, the correlation between metabolism, atherosclerosis and cancer was highlighted. Studies showed that weight gain may have a positive or a negative effect on some cancers. For example after menopause, breast cancer probability increases with obesity. However, overweight in girls and women before menopause, protects against breast cancer. Uterine cancer incidence increases with weight gain. Furthermore, prostatic cancer as well as colon cancer possibility increases in obese men. Diet rich in fish, fiber, vegetables and fruits is protective against cancer colon.
Last, but definitely not least, there was a lecture about atherosclerosis in the pharaohs. A team of cardiologists and Egyptian archaeologists analyzed the multi-detector computed tomography (MSCT) scans of the hearts of ancient Egyptian mummies. The group discovered that the ancient Egyptians had also suffered from atherosclerosis. The Pharaohs wrote in one of the papyrus that "if you experienced chest pain that extends to the left arm, then death is close". Although there was no cigarette smoking in the ancient Egyptian life, exposure to fumes at home during burning wood for warming or cooking can be one of the possible factors that facilitated atherosclerosis.

In summary, we quote the comment of Prof. Mohamad Said Fawzy (FRCP,FACC,FESC, prof of cardiology at 6th October University,Egypt) on the meeting: “The meeting was a very exciting and a valuable one because it updated us about the cellular level of atherosclerosis and its management. It stimulated young cardiologists and allowed them direct interaction with eminent cardiologists from Egypt and all over the world. The lecture about atherosclerosis in Egyptian mummies proves that it is an ancient historical problem”