cardiac patient during ramadan and hajj

The holy month of Ramadan is one of the five pillars of Islam. During this month, fasting Muslims refrain from eating, drinking, smoking, and sex from dawn until sunset. Although the Quran exempts sick people from the duty of fasting, it is not uncommon for many heart disease patients to fast during Ramadan. Despite the fact that more than a billion Muslims worldwide fast during Ramadan, there is no clear consensus on its effects on cardiac disease. Some studies have shown that the effects of fasting on stable patients with cardiac disease are minimal and the majority of patients with stable cardiac illness can endure Ramadan fasting with no clinical deterioration. Fasting during Ramadan does not seem to increase hospitalizations for congestive heart failure. However, patients with decompensated heart failure or those requiring large doses of diuretics are strongly advised not to fast, particularly when Ramadan falls in summer. Patients with controlled hypertension can safely fast. However, patients with resistant hypertension should be advised not to fast until their blood pressure is reasonably controlled. Patients with recent myocardial infarction, unstable angina, recent cardiac intervention or cardiac surgery should avoid fasting. Physician advice should be individualized and patients are encouraged to seek medical advice before fasting in order to adjust their medications, if required. The performance of the Hajj pilgrimage is another pillar of Islam and is obligatory once in the lifetime for all adult Muslims who are in good health and can afford to undertake the journey. Hajj is a physically, mentally, emotionally, and spiritually demanding experience. Medical checkups one or two months before leaving for Hajj is warranted, especially for those with chronic illnesses such as cardiovascular disease. Patients with heart failure, uncontrolled hypertension, serious arrhythmias, unstable angina, recent myocardial infarction, or cardiac surgery should be considered unfit for undertaking the Hajj pilgrimage

Coronary stent thrombosis in bare metal stents

The incidence of coronary stent thrombosis has reduced with improved techniques and drugs. Nevertheless, clinical trials may not reflect real world practice due to the selective inclusion criteria, regional variations and more complex patients treated in day-to-day practice. We examined the frequency, predisposing factors and outcome of stent thrombosis in unselected patients undergoing bare metal stents. All patients undergoing stent implantation are entered into a prospective database. We reviewed the incidence of stent thrombosis in our database for all patients with at least 6 months of follow up. From December 1996 through to December 2002, 1140 consecutive patients underwent a coronary stenting. Stent thrombosis occurred in 9 [0.8%] patients; 7 [78%] presented within 30 days of the procedure, while 2 had late stent thrombosis occurring after 30 days. The vessel was left anterior descending artery in all, 8 [89%] had a recent anterior myocardial infarction prior to the intervention and the mean stent length was 25 mm. The incidence of stent thrombosis is approximately 1% in the current era of intervention. Longer stent length in the left anterior descending artery following a recent myocardial infarction, seems to be associated with stent thrombosis