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

Baseline characteristics, management practices, and in-hospital outcomes of patients with acute coronary syndromes: Results of the Saudi project for assessment of coronary events [SPACE] registry

The Saudi Project for Assessment of Coronary Events [SPACE] registry is the first in Saudi Arabia to study the clinical features, management, and in-hospital outcomes of acute coronary syndrome [ACS] patients. We conducted a prospective registry study in 17 hospitals in Saudi Arabia between December 2005 and December 2007. ACS patients included those with ST-elevation myocardial infarction [STEMI], non-ST elevation myocardial infarction and unstable angina; both were reported collectively as NSTEACS [non-ST elevation acute coronary syndrome]. 5055 patients were enrolled with mean age +/- SD of 58 +/- 12.9 years; 77.4% men, 82.4% Saudi nationals; 41.5% had STEMI, and 5.1% arrived at the hospital by ambulance. History of diabetes mellitus was present in 58.1%, hypertension in 55.3%, hyperlipidemia in 41.1%, and 32.8% were current smokers; all these were more common in NSTEACS patients, except for smoking [all P < 0.0001]. In-hospital medications were: aspirin [97.7%], clopidogrel [83.7%], beta-blockers [81.6%], angiotensin converting enzyme inhibitors/angiotensin receptor blockers [75.1%], and statins [93.3%]. Median time from symptom onset to hospital arrival for STEMI patients was 150 min [IQR: 223], 17.5% had primary percutaneous coronary intervention [PCI], 69.1% had thrombolytic therapy, and 14.8% received it at less than 30 min of hospital arrival. In-hospital outcomes included recurrent myocardial infarction [1.5%], recurrent ischemia [12.6%], cardiogenic shock [4.3%], stroke [0.9%], major bleeding [1.3%]. In-hospital mortality was 3.0%. ACS patients in Saudi Arabia present at a younger age, have much higher prevalence of diabetes mellitus, less access to ambulance use, delayed treatment by thrombolytic therapy, and less primary PCI compared with patients in the developed countries. This is the first national ACS registry in our country and it demonstrated knowledge-care gaps that require further improvements

In-hospital adverse clinical outcomes of ST elevation myocardial infarction patients with renal dysfunction

To explore the prognostic value of baseline estimated glomerular filtration rate [eGFR] in Saudi patients presenting with ST elevation myocardial infarction [STEMI], and its impact on hospital therapies. The STEMI patients with a baseline serum Creatinine enrolled in the SPACE [Saudi Project for Assessment of Coronary Events] registry were analyzed. This study was performed in several regions in Saudi Arabia between December 2005 to December 2007. Based on eGFR levels, patients were classified into: more than 90.1 ml/min [normal renal function], 90-60.1 [borderline/mildly impaired renal function], 60-30 [moderate renal dysfunction], and less than 30 ml/ min/1.73 m[2] [severe renal dysfunction]. Two thousand and fifty eight patients qualified for this study. Of these, 1058 patients had renal dysfunction. Patients with renal dysfunction were older, and had a higher prevalence of risk factors for atherosclerosis. Patients with moderate or severe renal dysfunction were less likely to be treated with beta blockers, angiotensin converting enzymes inhibitors, statins, or reperfusion therapies. Significantly worse outcomes were seen with lower eGFR in a stepwise fashion. The adjusted odds ratio of in-hospital death in patients with eGFR less than 30ml/min was 5.3 [95% CI, 1.15-25.51,p=0.0383]. A low baseline eGFR in STEMI patients is an independent predictor of all major adverse cardiovascular outcomes, and a marker for less aggressive in-hospital therapy

effect of fasting in Ramadan on patients with heart disease.

To determine the clinical and biochemical effects of fasting during Ramadan on patients with cardiac disease. Eighty-six outpatients with heart disease with intention to fast were studied in the month of Ramadan 1996 [1416 H] at the King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia. Detailed clinical and biochemical assessments were performed within 3 days before the start of Ramadan and then on the last day of Ramadan. There were 54 [62.8%] males and 32 [37.2%] females with a mean age of 56.3 years [range, 17-84]. Forty-six patients [53%] had coronary artery disease, 23 patients [27%] had valvular heart disease, 13 patients [15%] had congestive heart failure and 4 patients [5%] were treated for arrhythmia. Sixty-two patients [72%] were in New York Heart Association [NYHA] Class I, 18 patients [21%] in Class II, and 6 patients [7%] were in Class III. Seventy-four patients [86%] managed to fast during the entire Ramadan, 9 patients [10.4%] missed the fasting for up to 7 days, and 3 patients [3.5%] could not fast. There were no significant changes in the NYHA Class [p=0.12]. No significant changes occurred in any of the hematological or biochemical parameters during the fasting of Ramadan. The effects of fasting during Ramadan on stable patients with cardiac disease are minimal. The majority of patients with stable cardiac disease can fast during Ramadan without significant detrimental effects

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