الفهرس 
Introduction & Aim of the Work9
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Abstract
It has been known since many years that almost all cardiovascular events exhibit a pronounced circadian rhythm with acute coronary syndromes, being more common in the morning. Several cardiovascular parameters (i.e., heart rate, blood pressure, vascular tone, and coagulation-fibrinolysis) show circadian pattern.
During the month of Ramadan, the change of meal schedule is accompanied with changes in sleep habits, such as delayed and shortened sleep periods, which may affect these circadian patterns. The other negative effects may be that during fasting, patients with cardiovascular disease cannot consume medications.
The aim of our study is to determine if fasting Ramadan has any effect on the circadian pattern of acute coronary syndromes or not. And to demonstrate the circadian pattern of acute coronary syndromes among fasting patients in Ramadan
The study included all patients with acute coronary syndromes who have been admitted to CCU in Assiut University Hospital during the month of Ramadan and the following 3 months after Ramadan. (The period between the 18th June 2015 to the 16th October 2015) then the patients were divided into two groups: fasting and non-fasting.
All the patients were subjected to full history taking including the time of onset of symptoms and time of presentation and seeking medical advice, full physical examination, ECG, cardiac enzymes.
Results showed that fasting patients were more likely to have their symptoms between 3 AM and 4 AM (15.3%) while non fasting patients were more likely to have their symptoms between 7AM and 8 AM (16.6%)
Fasting patients were more likely to present to hospital early within first hour of onset of symptoms (35.3%), while non fasting patients were less likely to present to hospital early within the first hour (23.7%)
Also the proportion of patients presenting with AMI and UA were not significantly different between fasting and non fasting group (45.9% and 54.1% vs. 50.9% and 49.1%).
Conclusion:
This study demonstrates that there are significant changes in the circadian presentation of patients with acute coronary syndromes in relation to Ramadan fasting, emphasizing the importance of the exogenous factors that are associated with fasting; namely, the changes in food intake and/or sleep timing, and their effects on the circadian rhythm of acute coronary syndromes.