Ramadan Fasting in Patients with Heart Disease

Risk Stratification

Moderate/Low Risk

May be able to fast.

High Risk

Should not fast.

Very High Risk

Must not fast.

Stable Cardiovascular Conditions (May be Able to Fast)

Stable Hypertension

Patients with stable hypertension may be able to fast.

Stable Angina

Patients with stable angina may be able to fast.

Stable, Non-Severe Heart Failure

Patients with LVEF >35% and HFpEF may be able to fast.

Implantable Loop Recorder

Patients with an implantable loop recorder may be able to fast.

Permanent Pacemaker

Patients with a permanent pacemaker may be able to fast.

Mild/Mild-Moderate Valvular Disease

Patients with mild or mild-moderate valvular disease may be able to fast.

Supraventricular Tachycardias/Atrial Fibrillation/Non-Sustained Ventricular Tachycardia

Patients with these conditions may be able to fast.

Mild/Moderate Pulmonary Hypertension

Patients with mild or moderate pulmonary hypertension may be able to fast.

High-Risk Heart (Should Not Fast)

Poorly Controlled Hypertension

Patients with poorly controlled hypertension should not fast.

Recent Acute Coronary Syndrome/Myocardial Infarction (<6 weeks)

Patients with recent acute coronary syndrome or myocardial infarction should not fast.

Hypertrophic Cardiomyopathy with Obstruction

Patients with hypertrophic cardiomyopathy with obstruction should not fast.

Severe Valvular Disease

Patients with severe valvular disease should not fast.

Very High Risk (Must Not Fast)

Advanced Heart Failure

Patients with advanced heart failure MUST NOT FAST.

Severe Pulmonary Hypertension

Patients with severe pulmonary hypertension MUST NOT FAST.

Dehydration is Dangerous

Fasting-associated dehydration may lead to electrolyte abnormalities which could be life-threatening in patients with unstable arrhythmias, inherited arrhythmia syndromes, or on specific medications.

Electrolyte Abnormalities

Dehydration may lead to life-threatening electrolyte imbalances.

Hypotension

Medications can induce hypotension, potentially precipitating syncope.

Medication Non-Compliance

Non-compliance with medications may be fatal, especially for patients on antiplatelets or anticoagulants.

Key Studies

Hypertension

Aslan et al found that Ramadan fasting decreased blood pressure in individuals using diuretics.

Chronic Coronary Syndrome

Khafaji et al reported that Ramadan fasting was not associated with increased cardiac mortality or morbidity in patients with chronic coronary syndrome.

Acute Coronary Syndrome

Temizhan et al noted no significant differences in the incidence of acute coronary syndrome in Ramadan compared to other months.

Heart Failure

Abazid et al demonstrated that patients with heart failure with reduced ejection fraction did not experience worsening HF symptoms with close monitoring.

General Recommendations

Hypertension

Blood pressure, kidney function, and medications should be reviewed by healthcare providers to reduce the risk of hypotension and/or worsening kidney function.

Coronary Artery Disease

Patients with chronic coronary syndrome and those within a 6-week period of an acute coronary syndrome are advised not to fast.

Heart Failure

Stable patients with non-severe Hf Ref may be able to fast, while those with severe Hf Ref and advanced HF are advised not to fast.

Intracardiac Devices

Patients with pacemakers may be able to fast, but those with cardiac resynchronization therapy or implantable cardioverter defibrillators are advised not to fast.

Category: Heart Disease

Tags: Coronary Artery Disease, Heart Disease, Heart Failure