Do's and Don'ts of fasting for heart disease patients

Ahead of the holy month of Ramadan when devout Muslims observe fast, a leading Indian cardiologist has come out with a set of Do's and Don'ts for people with heart diseases, cautioning patients of uncontrolled hypertension in particular.
Dr Upendra Kaul, Executive Director and Dean Cardiology at Fortis Escorts Heart Institute in New Delhi said that complete fast with no food or water from dawn to dusk can be taxing for patients with heart diseases. He has advised them as follows:
Hypertension: Patients with hypertension, who are often on multiple drugs, are advised to ensure before the beginning of the holy month that their blood pressure (BP) is reasonably well controlled.

There are several combination tablets which can be taken early morning before the start of fasting and after breaking the fast. Patients on diuretics should not take a high dose and preferably take the water pills in the evening.
Patients with uncontrolled hypertension should strictly refrain from going on fast.
Chronic heart failure: Patients with chronic heart failure, those with poor functioning of the heart, especially those with shortness of breath on exertion should avoid fasting on medical grounds.

However, patients who are well controlled and nearly symptom-free may observe Ramadan after taking precautions. They should avoid over eating after breaking the fast and have small helpings till morning.

Patients should take diuretics in the evening instead of morning, so that proper hydration can be maintained.
Angina and old Myocardial infarction: Patients with angina or chest pain and old myocardial infarction or heart attack who are able to perform normal activities can observe the fast; however, they should reduce their physical activity during the month.
People with a recent heart attack should refrain from observing fast on strict medical grounds.
Previous Angioplasty (Stenting) or Bypass surgery: Patients who have had angioplasty or a bypass surgery more than one year ago, and are able to perform routine activities, can observe the fast as long as they take all their medicines.

Strenuous physical activity should be avoided as it can cause dehydration which can produce blockage of stents or grafts.
Anticoagulant dependent patients: People who use blood thinners need to be careful. If they are doing well and have been on these medicines chronically and have a stable international normalised ratio (INR) of 2-3, they can observe fast. INR is used to determine the clotting tendency of blood.
It is advisable to get a blood test to evaluate the prothrombin rate before the start of the month of Ramadan to ensure that it is in therapeutic range.
In the hot summer months, undue exertion should be avoided to prevent contraction of blood volume leading to blood clotting.