The wonders of the heart anatomy and physiology

On the 5th of November, we discussed the association between the evidence from the two foundations of Islam: the Quran and Sunnah with the anatomy and physiology of the brain. The Quran and Prophetic traditions consist of religious, spiritual, scientific, medical and anatomical texts that act as a guide (Loukas et al., 2010). It is natural for me to discuss my favourite book, the Glorious Quran as a Muslim to research and contemplate on the beauty of its words and the wisdom behind its meanings. This section of the project aims to discuss the structure and function of one of the most vital organs in the body that has a strong relationship with the brain and; that is the heart. The heart is amongst the infinite blessings from Allah (The Most High) and; as we observe and analyse the various functions of the organs within the human body, we continuously contemplate the creativity and kindness of Allah (The Most High) in how they function 24 hours and 7 days a week. 

Allah (The Most High) states in the Glorious Quran:

"And if you should count the favours of Allah, you could not enumerate them. Indeed, Allah is Forgiving and Merciful."
[Quran, Surah Al-Nahl (The Bee), 16:18]

Over the centuries, clinical researchers have understood the impact that various anatomists, philosophers and artists have contributed to the gross anatomy of the heart from the ‘Father of Medicine’ Hippocrates to Galen to Leonardo Da Vinci (Roberts et al., 2019). Advances in understanding the structure and function in the post-Hippocratic era were about the interconnection between the lungs and the heart via the pulmonary circulation. The unsung hero, Ibn Al-Nafis made significant contributions to the earlier knowledge about the pulmonary circulation during the Islamic Golden age forming the link between Galen with scholars of the Rennaissance era: Michael Servetus, Realdus Columbus, Andreas Vesalius and William Harvey (West, 2008). 

However, how many of you knew it was the Quran that was revealed more than 14 centuries ago that initially provided humanity with the factual knowledge on the heart and the pulmonary circulation and their vitality in the maintenance of life?

 Allah (The Most High) states:
"Created man from a clinging substance."

[Quran, Surah Al-Alaq (The Clot), 96:2]

The 'clinging substance' or 'alaq' refers to the formation of a leech-like clot of blood from the uterine wall during the embryonic stage. Later in the developmental stages, it forms the pulmonary circulation where the heart has not started beating because it has developed the distinctive characteristics (Aga, 2020).

Therefore, the summary of literary works from the initial research on the cardiovascular system to its maturation and the framework of the Quran and Hadith provide evidence on the cellular, molecular and enzymatic levels. This provides an insight into the mechanisms that occur in the normal and abnormal circulation of the heart. 

Lancellotti et al. (2020) revealed that abnormal circulation and injury to the anatomical structures of the heart can lead to cardiovascular diseases and even tumours. Both diseases are the predominant causes of high mortality rates globally. Tumours of the heart are rare and are diagnosed as benign. Myxoma is the most common type that occurs in the left atrium of most paediatric patients but can in some cases occur in the right atrium. Rhabdomyoma is more of an advanced type of cancer and is linked with Tuberous sclerosis (National Institute of Cancer, 2009). 

Another example of a malignant tumour is angiosarcomas that is highly pleomorphic in nature even with immunohistochemistry. It is treated with neoadjuvant therapy (chemotherapy or radiotherapy) to shrink the tumour size before removing the micrometastases via surgery (National Institute of Cancer, 2009). Cardiotoxicity is one of the complications following cancer treatment and; this can cause autonomic dysfunction where there is variability in the heart rate and, it can also lower the cardiorespiratory fitness levels which affect the prognosis and survival rates of cancer patients (Grote et al., 2020). Grote et al. (2020) further added that when cancer patients conduct combined aerobic and resistance training (CART) at home or using minimal resources, it improves the fitness levels and maintain the sinus rhythm.

The Glorious Quran positions the heart at a lofty position from two respects: the physical and spiritual perspectives for intention, faith and understanding (Olatoye, 2013). From a physical perspective, the heart is a hollow muscular organ that pumps blood around the body via the circulatory system. It approximately beats 72 times per minute throughout our lives, this is ca. 4.7 – 5.7 litres of blood per minute. It approximately weighs 250 to 400 and 300 to 350 grams in the female and male respectively (Marieb and Hoehn, 2015). The function of the heart is to carry glucose, oxygen, amino acids, metal ions (sodium, calcium and potassium) to conduct vital functions, for instance: muscule contraction and homeostasis (Marieb and Hoehn, 2015). The blood also removes waste products which we do require for instance; carbon dioxide.

Within the spiritual context, Allah (The Most High) refers to the heart as its ability to process emotions, sentient, make intentions, actions, moral values, making the decision, and reasoning and intellectually suggesting its fundamental relationship between the heart and mind (Olatoye, 2013). 

Allah (The Most High) describes the heart 132 times in the Quran using three phrases: Qalb, Sadr (44 times) and Fuad (16 times) (El-Najjar, 2005). Qalb is derived from the word ‘qalaba’ which is the nature of the heart that can change something or turn it around (Loukas et al. 2010). Respected scholars such as Al-Ghazali (2005) reported that the Qalb refers to the physical and spiritual heart and; both require to be kept sound and healthy to operate. This relates to the following hadith where our Beloved Prophet (peace be upon him) refers the heart in a metaphorical sense and states:

“Truly in the body, there is a morsel of flesh which, if it is sound, all the body is sound and which, if it be diseased, all of it is diseased. Truly it is the heart.”
 [Hadith, Al-Bukhari, Muslim]

Other scholars such as Ibn Taimiyyah (1998) stated regarding this hadith that the heart is the commander and the limbs are the soldiers that follow. If the heart is good, the soldiers are good and; if the heart is evil; then the soldiers become evil and; it is important to love things only for Allah (The Most High). 

Another scholar, Ibn Hajer Al-Asqalani (2004) described the heart as singled out because it is the leader of the body in which through purification of the leader, the subjects become purified and when corruption occurs they become corrupted (Olatoye, 2013).

Sadr refers to the chest or breasts that entails the secrets where Allah (The Most High) states:
​
“Who whispers [evil] into the breasts of mankind” 
[Quran, Surah Al-Nas, 114:5]

Fuad refers to the heart as an organ that processes emotions, for example, when the mother of Prophet Moses (peace be upon them) had to put her newborn Moses in the river to protect him from the evil actions of the Pharoah.

But there came to be a void in the heart (Fuad) of the mother of Musa. 
[Quran, Surah Al-Qasas, 28:10]

Therefore, understanding the structure and function of the heart aids in diagnosing and treating cardiac diseases. The spiritual heart can be infected, for instance, sadness and anger; this affects the soul; whereas the physical heart can affect the body with disease. Advances in 3D imaging can be utilised to observe the segmented sections of the cardiac anatomy without influencing the relationship into the intrathoracic structures (Mori et al. 2019). 

The anatomy and physiology of the heart

The heart is a muscle that contracts and expands rhythmically and involuntarily. It is situated within the mediastinal cavity of the thorax between the right and left lung which; extends posteriorly to the second and fifth intercostal muscle as presented in Figure 1 (Jarvis and Saman, 2018). The main function of the heart is to pump blood around the body in conjunction with blood vessels using the Cardiac cycle where the heartbeats 72 times per minutes. It has a helical and circumferential structure to aid in its mechanical activity (Buckberg et al. 2018). Buckberg et al. (2018) discovered that the cardiac dynamics influences the movement of the cardiac muscle in particularly the left ventricle, right ventricle and septum where narrowing, lengthening, twisting, shortening, uncoiling and widening occurs. 

The heart consists of layers: the outer layer is the pericardium which prevents it from overexpanding the thorax and is attached to the inner sternal surface in the anterior end and diaphragm at the posterior end. It is subdivided into two layers: fibrous layer which contains a dense layer of connective tissue and the serous pericardium also, known as the epicardium (Jarvis and Saman, 2018). The serous fluid separates both of the pericardial layers to provide a smooth motion. The middle layer is the myocardium that comprises of cardiomyocytes (cardiac muscle cells) and; the inner layer is known as the endocardium (Jarvis and Saman, 2018). 

Figure 1: The location of the heart within the chest cavity.

Inside the heart, there are four compartments called a chamber - Figure 2. The upper chamber is called the atrium whereas; the lower chamber is called the ventricle. Each side of the heart has two chambers and; there is a thick muscular wall called a septum that separates the right and left side of the heart. The left ventricle has a circular cavity with a thicker wall in comparison to the right ventricle that has a crescent cavity and thinner wall (Marieb and Hoehn, 2015). The presence of the four cardiac valves prevents the backward flow of the blood. The valves have cusps (projections) where the chordae tendinae (tendons) are bound with the inner cardiac walls by papillary muscles. 

Figure 1: The anatomical structure of the heart (Franklin Institute, 2020)

The blood and the pulmonary circulation

Amongst the cells found in the blood are red blood cells (erythrocytes) that carry oxygen to each cell around the body. They contain a red pigment called haemoglobin that covalently binds with oxygen to form oxyhaemoglobin. The red blood cells carry oxygen into the cells where it utilised and; carbon dioxide is carried away from the blood.

The artery blood vessel carries blood away from the heart and; the veins carry blood back to the heart. This movement of blood is called circulation where; it is estimated that it takes 60 seconds to pump blood to each cell. The arteries are divided into smaller blood vessels called arterioles and then even smaller branches called capillaries. The veins are divided into smaller blood vessels called venules.

The right atrium receives deoxygenated blood from the inferior and superior vena cava as presented in Figure 3. The deoxygenated blood from the head and neck is via the superior vena cava whereas; the inferior vena cava receives deoxygenated blood from the rest of the body. This then flows into the right ventricle. The tricuspid valve separates the right atrium and ventricle and has three cusps. Its function is to allow the deoxygenated blood to flow through (Marieb and Hoehn, 2015).

The right ventricle pumps the deoxygenated blood through the pulmonary trunk into the lungs where it collects the oxygen molecules. The gas exchange particularly takes place in the alveoli of the lungs. The pulmonary trunk consists of left and right pulmonary arteries. The pulmonary valve separates the right ventricle and the pulmonary artery and this allows the flow of deoxygenated blood to enter the lungs (Marieb and Hoehn, 2015). 

The oxygenated blood is returned to the heart where it enters the left ventricle via the pulmonary vein. This explains why the left ventricular wall is thicker to withstand the pressure of oxygenated blood. The bicuspid valve also; known as the mitral valve has two projections and; it allows the flow of oxygenated blood from the left atrium to the left ventricle (Marieb and Hoehn, 2015).

From the left ventricle, there is an aortic valve where the oxygenated blood flows through into the aorta and; this is transported around the body (Marieb and Hoehn, 2015). To summarise, the bicuspid and tricuspid valves function in the flow of the blood from the atria to the ventricles whereas; the aortic and pulmonary valves function in regulating the flow of blood leaving the heart. 

Concerning the evidence found in the Quran, the blood has been mentioned in terms of menstruation, the blood of animals, embryology and lineage. Allah (The Most High) states:

"And We have already created man and know what his soul whispers to him, and We are closer to him than [his] jugular vein."

[Quran, Surah Qaf (Letter Qaf), 50:16]

This illustrates that the close distance of Allah (The Most High) to oneself is more important than the close distance of the blood vessel more than the importance of this blood vessel. The jugular vein is divided into interior and exterior and functions in returning deoxygenated blood from the brain, face and neck to the heart via the superior vena cava. 

Another evidence of the blood vessel in the Quran is in the following verse:

"And if Muhammad had made up about Us some [false] sayings, We surely would have seized him by his right hand (or with power and might), And then We certainly would have cut off his life artery.” 

[Quran, Surah al-Haqqah (The Reality) 69:44-47]

The scholars have mentioned that Al-Watin is the ‘aorta’ or an artery where if Prophet Muhammad (peace be upon him) lied about the teachings of Islam, the vital artery would be cut. From a positive aspect, it is in reference that the blood is the vehicle of life and survival based on the exegesis (Abdel Haleem, 2005). 

In relation to menstruation, it is advised to not do sexual intercourse nor prayer because of impurity and the ability to transmit pathogens via the blood causing infection. 

And they ask you about menstruation. Say, "It is harm, so keep away from wives during menstruation. And do not approach them until they are pure. And when they have purified themselves, then come to them from where Allah has ordained for you. Indeed, Allah loves those who are constantly repentant and loves those who purify themselves." 

[Quran, Surah Al Baqarah (The Cow) 2:222]

There is another type of circulation and that is through the coronary arteries. It arises from the openings of the aorta called the coronary ostia and is situated in the epicardium and myocardium (Marieb and Hoehn, 2015). Its function is to supply the heart with oxygenated blood. The left coronary artery goes through the left side of the heart and is subdivided into the left circumflex and descending arteries. The right coronary artery goes through the right side of the heart and is subdivided into the marginal and posterior arteries (Marieb and Hoehn, 2015).

Approximately two-thirds of the venous blood returns to the heart, in particular, the right atrium via a structured network of coronary veins called the coronary sinus that varies in types: small, middle, large and oblique, marginal and posterior veins. The last third of the venous blood enters the right atrium directly via the anterior cardiac veins (Marieb and Hoehn, 2015).

Figure 3: The pulmonary and system circulations

The regulation of the heart

The heart is regulated by the conduction system and the cardiac cycle. At first, the atria and ventricles relax in a coordinated manner; this is called diastole. To generate an electrical impulse, it requires a sequence of excitation that takes place in the cardiac muscle cells. There are two nodes: sinoatrial (SAN) and atrioventricular (AV) and these are specialised tissues that aid in the electrical activity of the heart.

​The SAN is situated in the right atrium and sets the sinus (heart) rhythm to initiate the electrical impulse following the contraction of the myocardium as presented in Figure 4. This then enters the atrium to contract (atrial systole) and is transmitted to the AV node that resides in the inter-atrial septum. This is done via three atrial internodal tracts: the left atrium via the Bachman’s bundle to the AV node, the middle internodal tract where there is the Wenckebach Bundle and; this flows from the septum to the AV node to conduct different speeds. The third way is from the posterior Internodal tract otherwise; known as the Thorel’s tract and; this occurs from the lower septum of the AV node. There is a minimal delay of 0.1 seconds of the AVN because of its smaller size and; this gives enough time for the atria to contract and fill 70% of the ventricles.  The blood filling the ventricles is called the end-diastolic volume. 

The electrical impulse subsequently goes to the intraventricular septum to induce ventricular contraction (ventricular systole) whilst the atria relax and; this occurs via the insulated fibres called Bundle of His at the apex of the heart. The Bundle of His are subdivided into left and right bundles and contain papillary muscles. The non-insulated fibres: Purkinje fibres resides in the ventricular myocardium and travel into the right and left ventricles. The ventricles contract as the pressure increases and; this pushes the blood out of the aortic and pulmonary valves via the aorta arteries. 

The diastolic phase then occurs again and; this is where the ventricles relax as the ventricular pressure descends and; this causes the aortic and pulmonary valve to close. The remaining blood in the chambers is called the end of the systolic volume also; known as the isovolumetric relaxation. The diastole, atrial systole and ventricular systole events form the cardiac cycle - Figure 4 (Marieb and Hoehn, 2015). 
Furthermore, several chemicals affect the contractility of the heart, for instance, adrenaline and thyroxine – catecholamine and hormone respectively to induce a positive inotropic effect. On the other hand, calcium channel antagonists can have a negative inotropic effect on the heart (Marieb and Hoehn, 2015).

Figure 4: The regulation and coordination of the heart 

The heart from a spiritual perspective

Despite my research project focuses on the anatomy and physiology of the heart, understanding how the heart and mind particularly the hypothalamus conjugate together to facilitate emotions, reasonings, the understanding of actions by intentions and acceptance of knowledge centralises their purpose within human nature. It can be Shubahat (level of understanding) or Shahawat (self-desire that grow out of proportion)(Loukas, et al. 2010). Allah (The Most High) states:

"Truly it is not the eyes that become blind but do the hearts which are in the chests" 
[Quran, Surah Al-Hajj, 22: 46]

Many researchers have discovered that there is a strong correlation between the heart and the brain. Previously in this project, we have covered the six senses and; these are considered external areas whereas; emotion is considered internal and; both forms are required to facilitate feelings and bridge the mind and heart (Sempo et al., 2017). The Glorious Quran particularly influences the sound and sight senses.
Many Quranic verses and Hadith use the terms: 'in the heart' and 'from the heart' to describe the cardiac state. The good heart is of the Al-Muminoon (The Believers) and; it connotates happiness, gratitude, faithful, love, gentleness mercy, a balanced rational and other positive traits. It is a heart that fears and loves Allah (The Most High) and remembers Him through supplication, worship, seeking repentence and using each moment wisely in preparation for the Hereafter (Afterlife). It is free from Shahawat and relies on Allah (The Most High) - Nafs Al Mutmainah - a satisfied soul (Tahmasebi, 2015; Olatoye, 2013).

It was narrated that Abu Hurairah (May Allah have mercy upon him) reported that our Beloved Prophet Muhammad (peace be upon him) said:
"People whose hearts are like the hearts of birds will enter Paradise".
[Hadith, Muslim, 2840]

In reference to this hadith, Al-Nawawi (may Allah have mercy upon him) stated it means that they are those who rely upon Allah (The Most High) and have soft hearts.

The second type of heart is referred by the scholars as bad or dead hearts of the Non-Believers. This is due to their harshness, acts of aversions, arrogance, suspicion, sins and other negative traits. It has no life and follows worldly pleasures. It is the Nafsul Ammarh - a commanding soul (Tahmasebi, 2015; Olatoye, 2013).

The third type of heart is the diseased or sick hearts of the hypocrites who have feelings of emptiness, weakness and are terrified. They harbour between the good and bad heart where there is the love of Allah (The Most High) and is also dead because of the desires - Nafsul Lawwammah (the complaining soul) (Olatoye, 2013).

Ibn Qayyim Al-Jawziyyah (2000) has described the diseased heart with not feeling pain when sinning, finding pleasure when disobeying Allah, not influenced by admonition, lack of prioritisation of what is important, difficulty in accepting the truth and a feeling of discomfort amongst righteous believers. Our Beloved Prophet (peace be upon him) made the following supplication (dua) and was narrated by Ibn Umar (may Allah have mercy upon him):

"O’ Allah, I seek refuge in you from a heart without conscious fear of Allah, a prayer unanswered, an unsatisfied soul, and knowledge with no benefit. I seek refuge in You from these four things!"
[Hadith, Al-Nasai, 43]

This emphasises the diseased heart has no conscious fear of Allah (The Most H igh). Besides, El-Najjar (2005) gave an additional type of heart and; it is the heart that reasons with its ability to process thinking, rewarding, reasoning and punishment. ​A summary of some of the Quranic evidence of the types of hearts can be found in Table 1.

Table 1: The Quran evidence on the different types of heart

The heart influences the brain and the rest of the body neurologically via the nervous system, biophysically through the pulse waves and electromagnetically via the energetic waves (Loukas et al., 2010). Its strong rhythm branches out the electromagnetic field and; it is sensed by every cell of the body processing information - this is known as the heart code (Pearsall, 1999).

The heart has been described by Tahmasebi (2015) as a cognitive tool that hears the words of Allah, maintaining faith and performance of righteous acts to fulfil our divine purpose. Allah (The Most High) states:

"Those who have believed and whose hearts are assured by the remembrance of Allah. Unquestionably, by the remembrance of Allah hearts are assured."

[Quran, Surah Al Raad (The Thunder), 13:28]

This suggests how the Quran (The Most High) can provide a healing status on the nervous, hormonal and immune system. Many studies emphasise how stress and pessimism is an independent risk factor that can stimulate the inflammatory process causing hypertension and coronary heart disease (Kurd et al. 2013; Vale, 2005). On the other hand, people with an optimistic vision and good lifestyle management strategies are calm. 

It was reported by Pearsall et al. (2005) that following peripheral organ transplants such as the heart, it affects the behaviour and personality traits that are proportional to the donor and this is because of the systemic memory and decider subsystems in place. This is a similar case with kidney and liver where sensations change towards food, and emotional factors are linked with the donor's history (Joshi, 2011). However, these transitional changes could be caused by immunosuppressant drugs, stress and psychopathology of the donors (Pearsall et al. 2005; Joshi, 2011). Allah (The Most High) states:

"Did We not expand for you, [O Muhammad], your breast?"
[Quran, Al-Sharh (The Relief), 94:1]

Many of the scholars agreed that this is a metaphorical reference about Allah (The Most High) opening the heart of Prophet (peace be upon him) about Islam, faith and knowledge in the reports of Al-Bukhari and Al-Basri in their commentaries of Surah Al-Sharh. Ibn Ashur (2000) further suggests that this is in reference to the levels of perfection and blessings upon him from Allah (The Most High) because Allah is pleased with him. Ibn Uthaymeen (may Allah be pleased with him) mentioned in his Tafseer that the opening of the heart is related to the decree of Allah (The Most High) in terms of religion and the calamities or trials that man faces.

Ibn Kathir (1988) reported that this verse is similar to the following verse:

"So whoever Allah wants to guide - He expands his breast to [contain] Islam; and whoever He wants to misguide - He makes his breast tight and constricted as though he were climbing into the sky. Thus does Allah place defilement upon those who do not believe."

[Quran, Surah Al-Anaam (The Cattle) 6:125]

On the other hand, other scholars mentioned that this is about the surgical opening of the heart that occurred twice where there are hadiths concerning the events when he was small and the other during the night of Israa (The night Journey).

It was narrated from Anas ibn Malik (may Allah have mercy upon him) that Jibreel (may Allah be pleased with him) came to Prophet Muhammad (peace be upon him) when he was playing with the other boys in the Banu Saad tribe. He took hold of him and threw him to the ground, then he opened his chest and took out his heart, from which he took a clot of blood and said: “This was the Shaytan’s share of you.” Then he washed it in a vessel of gold that was filled with Zamzam. Then he put it back together and returned it to its place. The boys went running to his mother – meaning his nurse – and said: Muhammad has been killed! They went to him and his colour had changed. Anas said: I used to see the mark of that stitching on his chest.

[Hadith, Muslim, 162]

Abu Dharr narrated that Prophet (peace be upon him) said: 

“The roof of my house was opened when I was in Makkah, and Jibreel (may Allah be pleased with him) came down and split open my chest, then he washed it with Zamzam water. Then he brought a golden basin filled with wisdom and faith and emptied it into my chest. Then he sealed it."
​
[Al-Bukhari; 349 and Muslim; 163]

Ibn Al-Hajar Al-Asqalani (2004) mentioned that some scholars disagree that the open heart surgery took place during the night journey and only occurred when Prophet (peace be upon him) was young. However, he and Al-Qurtubi (1996) added there is various strong evidence that suggests the second event did occur and should not be objected. The ultimate point of mentioning this event is that following this incident, Prophet (peace be upon him) had a significant change in his outward approach towards Islam and belief.

Ramadan and the cardiac patient

Ramadan is the holy month for Muslims where they fast from dawn until sunset and perform good deeds (Chamshi-Pasha, 2013). It is put forward ca. 10 days before the previous year. Amongst those exempt are the elderly, the pregnant, breast-feeding, very young children, those who are travelling and the unwell, for instance, people with heart disease and diabetes. Allah (The Most High) states:

"O you who have believed, when you rise to [perform] prayer, wash your faces and your forearms to the elbows and wipe over your heads and wash your feet to the ankles. And if you are in a state of janabah, then purify yourselves. But if you are ill or on a journey or one of you comes from the place of relieving himself or you have contacted women and do not find water, then seek clean earth and wipe over your faces and hands with it. Allah does not intend to make difficulty for you, but He intends to purify you and complete His favor upon you that you may be grateful."

[Quran, Surah Al-Maidah (The Table), 5:6]

However, a few studies have revealed that there are positive effects of fasting in cardiac patients. Temizhan et al. (1999) compared patients with acute coronary heart disease and unstable angina before, during and after Ramadan and discovered that the mortality rates decreased in Ramadan in comparison to prior or post-Ramadan (p=0.03). However, amongst the limitations of this study is that the sample population size was small (1655) to discover whether there was a significant difference. 

On the other hand, Salim et al. (2013) reported no significant difference between before and after fasting Ramadan. There were no alterations in the blood pressure, body mass index and lipid profile of patients with stable cardiac illness wherein the latter there was 30-40% improvement in the level of high-density lipoproteins. However, diabetic patients must be monitored (Salim et al., 2013).

Another study revealed that intermittent fasting that includes restricting the number of calories help improve the cardiovascular and neural function via the neurotrophic factor signalling pathway in the brain which increases sensitivity to insulin and lowering the blood pressure (Mattson and Wan, 2005). These findings can lead to the discovery of novel therapeutic modalities. However, the effect of fasting varies with each patient and should comply with optimised treatment and dietary needs. 

Pilgrimage and the cardiac patient

​When Muslims go on the annual pilgrimage (Hajj) that takes place in Makkah, several symptoms can occur in patients with heart disease, for instance, thirst, sun exposure and communicable diseases such as respiratory infections (Chamsi-Pasha, 2013). This is why the patient must consult their General Practitioner (GP) before the journey to do a health check, ensure there is a compliant supply of medications and provide the necessary advice. Avoiding crowds is also a preventative measure to prevent cardiac decompensation (Chamsi-Pasha, 2013). 

A recent study by Yilmaz et al. (2019) discovered that there was a significant difference in the number of times medicines were used before and after Hajj (pilgrimage) (p=0.011). However, in the three-month follow up, there was no difference nor complaints after Hajj (p=0.094). This suggests how the treatment compliance differs with the period of time wherein the short-term interval there is a negative effect whereas; in the long-term, it is positive or has no difference (Yilmaz et al., 2019).

There are many ways of how to take care of the heart from a spiritual and physical sense and; that is through lifestyle management, praying and type of food. The Muslim prayer is a combination of standing, sitting and prostrating and; the units of prayer varies with each prayer. Loukas et al. (2010) informed that the movements of prayer helps digest food and stimulate the leg muscles gastrocnemius and soleus to increase the return of venous blood to the heart when standing and displaces the blood from the two veins: peripheral and central veins to prevent oedema and decrease the formation of a thrombus (Loukas et al., 2010).

Furthermore, it is understood that Muslims do not eat the meat of the pigs and; there is scientific reasoning behind this. There is high level of fat and contain Trichinella parasite that can cause infection (Vasilev et al. 2012). Besides, healthy food, for instance, talbina (barley) is recommended for cardiac patients.

Overall, the Quran and Hadith have significant revelations on the physical and spiritual concepts of the heart more than 14 centuries ago and this facilitates in seeking knowledge on nature at an exponential rate in combination with the literature, particularly, the anatomy and physiology of various organs of the body forming a clear consensus. This section of the project leads us to subsequently discuss next month, the anatomy and physiology of the bone where the red blood cells that carry oxygen in the blood around the body are made.

Figure 5: An insight of the red and white blood cells in the bone.

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