Background: A pacemaker is a device implanted in the chest to help people with symptomatic bradycardia and life-threatening irregular rhythm. However, it is also associated with many complications. Therefore, this study evaluated pacemaker-related complications and factors associated with them, as there is little data on pacemaker-related complications in sub-Saharan Africa and Ethiopia. Methods: The study was conducted on 118 patients over 18 years old who had pacemakers implanted between 2017 and 2022 at Tikur Anbessa Comprehensive Specialized Hospital in Addis Ababa, Ethiopia who were reviewed by the authors from September 2022 to December 2022. Sociodemographic factors, clinical characteristics, and complications data were extracted using a structured questionnaire by retrospective review of patient records. The chi-square test or Fisher’s exact test was performed to evaluate factors associated with complications. Results: The median age of patients was 60.5 years (IQR = 15 years), with men accounting for 50.8% of patients. Hypertension was the most common comorbidity (64.2%). Symptomatic grade 3 AV block was the most common indication (78.8%) for pacemaker implantation. With a mean follow-up of 3.92 ± 1.94 years, 15.3% of patients had complications. Pneumothorax, pocket site infection, and lead dislodgement were the most common complications occurring in 2.54% of patients each. Patient age during surgery (p-value = 0.02), patient gender (p-value = 0.04), pacemaker implanting team (p-value = 0.01), and adherence to follow-up (p-value = 0.04) are related to pacemakers-related complications. Conclusion: Pacemaker implantation is associated with many complications. Pneumothorax, pacemaker pocket infection, and lead dislodgement were the most common complications. Patient age at pacemaker implantation, patient gender, pacemaker implanting team, and follow-up compliance were factors associated with pacemaker-related complications. Skill development through specialized training and compliance counseling may improve outcomes for patients who have complications related to pacemaker implanting team and poor adherence to follow.

Heart failure (HF) and atherosclerosis represent two major cardiovascular diseases that are intricately linked, both contributing significantly to global morbidity, mortality, and healthcare burden. Despite substantial progress in diagnostic methods and therapeutic strategies, the overall impact of these conditions remains considerable. This is largely due to their complex and overlapping pathophysiological mechanisms, persistent residual atherosclerotic risk, and the ongoing challenges associated with implementing guideline-directed medical therapy for HF in routine clinical practice. Recent advancements in the management of diverse HF phenotypes, lipid abnormalities, atherosclerotic cardiovascular disease (ASCVD), and obesity have facilitated the adoption of multidrug regimens. These include beta-blockers, renin-angiotensin-aldosterone system inhibitors, and sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1), which have collectively improved outcomes in HF populations. This review aims to elucidate the shared pathophysiological mechanisms linking these conditions and to examine their clinical overlap with ischemic heart disease, cerebrovascular disease, peripheral arterial disease, dyslipidemia, and obesity.

Percutaneous balloon pulmonary valvuloplasty (BPV) is the preferred treatment for pulmonary valve stenosis owing to its effectiveness and safety in patients with appropriate valves. However, there is a lack of research on the immediate and midterm results in developing nations. Thus, this study aimed to evaluate the immediate and midterm outcomes of patients who underwent BPV at the Cardiac Center of Ethiopia. A follow-up study was conducted from April 2023 to August 2023 using retrospective chart reviews and phone interviews involving 138 patients aged ≤ 18 years who underwent balloon BPV for moderate to severe pulmonary stenosis (defined as peak pulmonary valvular gradient ≥ 50 mmHg) at the Cardiac Center of Ethiopia between January 2012 and March 2023. The study’s primary objective was to assess the procedure’s immediate success and mid-term outcomes. The study employed various statistical tests, including a multivariable logistic regression model, to identify predictors of the development of moderate to severe pulmonary regurgitation and restenosis. The patients’ median age was 3.95 years (1.5–13 years), with a female to male ratio 1.6. Following BPV, there was a significant decrease in the median peak pulmonary trans-valvular gradient from 106 mmHg to 40 mmHg (p < 0.001). The immediate success rate was 71%, with post-procedural complications at 4.3%. In a median follow-up of 114 months (IQR 72–132 months), 34.1% developed moderate to severe PR, and restenosis occurred in 24.4%. High balloon annulus ratio predicted moderate to severe PR, while dysplastic or complex pulmonary valve, high pre-procedural and immediate post-procedural peak gradients, and high pre-procedural left ventricular systolic pressure predicted restenosis. Most patients typically achieve initial success following BPV at our center. However, it is not unusual for moderate to severe pulmonary regurgitation and restenosis to develop during follow-up. As such, this study underscores the significance of thorough follow-up care for patients who underwent BPV to promptly detect and address potential complications.

Rarely observed during pregnancy and the postpartum period, right side infective endocarditis (IE) is particularly uncommon among non-drug-addicted individuals. Nonetheless, if it does occur, it poses significant health risks for both the mother and the fetus, even in the absence of pre-existing heart diseases. This case report describes a rare presentation of right-sided IE (IE) in a 40-year-old woman from rural Ethiopia with postpartum endometritis. The patient presented with atypical symptoms, making it challenging to identify the underlying cause. Through careful diagnostic evaluation and a multidisciplinary approach, the team successfully diagnosed and treated the patient, highlighting the importance of swift and accurate diagnosis for managing uncommon right-sided IE cases.

Rheumatic heart disease (RHD) remains highly prevalent in low-income countries and is associated with severe complications and premature mortality. Limited local evidence in Ethiopia hinders understanding of disease progression and risk stratification. This study aimed to assess patterns of complications, survival, and predictors of mortality among adults with RHD in Ethiopia. We conducted a retrospective cohort study of 1,811 adults (≥ 18 years) with definite RHD diagnosed by transthoracic echocardiography according to the 2012 World Heart Federation criteria. Patients received care at the Cardiac Center of Ethiopia between January 1, 2015, and January 1, 2025. Complications and mortality were summarized descriptively. Survival was estimated using Kaplan–Meier methods and compared with log-rank tests. Independent predictors of mortality were identified using multivariable Cox proportional hazards regression. The median age was 32 years, with a female-to-male ratio of 1.5:1. Over a median follow-up of 5 years (IQR 2.5–6.5), 1,037 participants (57.3%) developed at least one complication, most commonly New York Heart Association (NYHA) class III–IV heart failure with pulmonary hypertension (31.4%) and isolated pulmonary hypertension (19.8%). A total of 326 participants (18.0%) died, with significantly lower survival among those with complications (p < 0.001). Independent predictors of mortality included presence of comorbidities (AHR 5.8), increased left ventricular internal diastolic diameter (LVIDd) (AHR 2.1), monthly income < 2,000 Ethiopian birr (≈ 13 USD) (AHR 1.2), NYHA class III–IV heart failure (AHR 2.2), and pulmonary hypertension (AHR 2.4). Adults with RHD in Ethiopia experience high rates of complications and premature mortality, driven by advanced heart failure, pulmonary hypertension, ventricular dilation, comorbidities, and socioeconomic disadvantage. Early detection, optimized chronic disease management, and expanded access to surgical and percutaneous interventions are urgently needed to improve outcomes in this resource-limited setting.

Kounis syndrome (KS) describes the occurrence of acute coronary syndromes precipitated by allergic, hypersensitivity, or anaphylactic reactions and represents a unique intersection between immunologic activation and cardiovascular disease. The epidemiology of KS is likely underestimated due to diagnostic overlap with other cardiac and allergic conditions and limited awareness across medical specialties. This narrative review focuses on the distinctive features of KS in special populations, emphasizing how patients’ age, comorbidities, immune status, and vascular substrate modify presentation, diagnosis, and outcomes. In elderly patients, polypharmacy, increased plaque vulnerability, and endothelial dysfunction favor Type II and III KS. Pediatric cases, although rare, are predominantly Type I and strongly associated with food allergies, insect stings, vaccines, and antibiotics, with under-recognition driven by diagnostic bias and ethical concerns surrounding invasive testing. Patients with coronary stents, cardiac devices, chronic kidney disease, and those receiving dialysis exhibit heightened susceptibility due to chronic inflammation, foreign-body hypersensitivity, and prothrombotic states. Pregnancy and the peripartum period represent a unique immuno-hemodynamic milieu in which Th2 immune shift, increased coronary vasoreactivity, and obstetric triggers can compromise both maternal and fetal perfusion. Additional risk modulation is observed in atopic individuals, asthmatics, patients with autoimmune, inflammatory, oncologic, psychiatric, and neurodevelopmental conditions, as well as in COVID-19 and post-infectious states. We propose a host-modified framework for KS that complements traditional classification by integrating immune phenotype and vascular substrate, enabling improved risk stratification and personalized preventive strategies.