Approach to Ramadan Fasting In Patients with Heart Diseases

Holy month ramadan is auspicious for worldwide muslims and most of them starts fasting early in the morning up to the sunset in the evening during this entire month.

Heart disease patients tend to fast during ramadan but they have many questions:

1. Cardiac patients can fast?

The holy Quran exempts sick people from fasting. Fasting is allowed only for stable heart disease patient and it's strictly the discretion of the treating cardiologist.

Common types of cardiac conditions as follows:

A. Patients who had heart attack or recent stenting or open heart surgery

Many studies comparing ramadan with other months in cardiac patients shows there is no significant differences in the incidence of heart attack or typical cardiac chest pain during ramadan. Patients with recent acute heart attack, heart attack equivalent chest pain with high cardiac enzymes, recent stenting, recent open heart surgery should strictly avoid fasting.

B. Patients with low pumping of heart i. E, reduced ejection fraction 

Low pumping of the heart is one of the common cause of frequent hospitalisations among cardiac patients. Many studies done in the middle east shows there was no significant difference in the number of hospitalizations for patients with low heart pumping during ramadan. Its almost similar to other months without fasting. But in this category certain groups of patients cannot fast especially patients with difficulty in breathing, associated swelling of legs, associated cough and sudden increase in weight.

C. Patients with high blood pressure.

Most of the high blood pressure patients on controlled medications can fast during ramadan as it will not affect the blood pressure readings and it was proved in many studies. Certain group of patients with resistant blood pressure who requires multiple drugs for controlling should consult treating doctors before ramadan for appropriate dose adjustments. If dose adjustment is not possible then for such patients it is advisable to abstain from fasting to avoid cardiac and other complications.

2. How to take their cardiac drugs during this month?

Stomach ulcer and related complications are common during ramadan. Hence drugs which can cause gastric irritation (like aspirin) should be taken as per the advice of treating doctor. Before ramadan you should consult your doctor and make sure regarding the dose and timing. Medications like water pill (lasix)to be avoided during fasting.

3. Lifestyle during ramadan

Avoid over eating while breaking the fast

Avoid exercise after a large meal

Stop smoking

4. Can cardiac patients do hajj pilgrimage?

Cardiac patients who is certified as stable and fit by the treating cardiologist can go for hajj

Full medical workup is mandatory before hajj.

Patients with recent acute heart attack, heart attack equivalent chest pain with high cardiac enzymes, recent stenting, recent open heart surgery are unfit for hajj.

Take home messages-:

A. Consult your doctor before ramadan regarding your health condition and dose adjustments if required.

B. Comply to medication

C. High risk patients should avoid fasting

D. Unfit cardiac patients should not try hajj pilgrimage.