Complications of a heart attack

Although there are many possible complications of a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., these are becoming less common thanks to improvements in medical care. Complications may include:[1,8]

Abnormal heart rhythms

Abnormal heart rhythms are called arrhythmias - this means there is a problem with either the rate or the rhythm of the heartbeat, or both.

Arrhythmias are very common in people who have had a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. and may not last long; the heart usually goes back to its normal rhythm with pain relief, rest and the correction of abnormal potassium levels.[1] Sometimes, though, they persist and need treatment.

Atrial fibrillation is a common type of arrhythmiaAn abnormal heart rhythm. where the upper two chambers of the heart, the atriaThe two upper chambers of the heart. (singular: atriumOne of the two upper chambers of the heart.), do not pump properly. Atrial fibrillation may be triggered by a number of factors, such as low levels of oxygen and low potassium levels.[9]

Often, atrial fibrillationA common abnormal heart rhythm causing a rapid, irregular pulse and failure of the upper chambers of the heart (atria) to pump properly. Abbreviated to AF. does not need any treatment at all, although a controlled, precise shock to the chest may be administered. This is called cardioversionA procedure to correct an abnormal heart rhythm, by either a controlled shock or medication. and may be necessary if the atrial fibrillationA common abnormal heart rhythm causing a rapid, irregular pulse and failure of the upper chambers of the heart (atria) to pump properly. Abbreviated to AF. is associated with very low bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure. It may also be treated with medication such as digoxin, and medicines to help prevent the formation of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clots - anticoagulants.[1,9]

Ventricular fibrillation is a type of arrhythmiaAn abnormal heart rhythm. involving the lower two chambers of the heart, the ventricles. It is much more serious and must be treated by cardioversionA procedure to correct an abnormal heart rhythm, by either a controlled shock or medication. immediately.[1,10]

Other types of arrhythmiaAn abnormal heart rhythm. include a slow, regular rhythm - sinus bradycardiaA slow, regular heart rhythm. - and a block in the electrical conductionThe transmission of, for example, electricity, heat or sound. of the heart between the upper and lower chambers - called atrioventricular blockA block in the normal conduction of electrical activity between the upper and lower chambers of the heart (atria and ventricles). or bundle branch blockA block in the normal conduction of electrical activity in the heart.. The latter is usually treated with a temporary pacemakerA small electrical device that functions to maintain a normal heart rate..[1,11]

The number of people having a stroke after a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. seems to be decreasing.

Angina

In spite of the successful use of 'clot-busting' drugs (thrombolysisBreaking up a blood clot by administering medications called thrombolytics.), many people who have a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. are left with some degree of blockage in the affected coronaryRelating to the arteries supplying the heart itself. arteryA blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood.. This limits bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. flow to the heart muscleTissue made up of cells that can contract to bring about movement. and means that anginaA central chest pain caused by insufficient oxygen supply to the heart. after a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. is quite common.[1,12] Learn more about anginaA central chest pain caused by insufficient oxygen supply to the heart. and its causes.

Learn more about angina.

Inflammation of the membranes surrounding the heart

Inflammation of the membranes surrounding the heart - the pericardiumThe sac surrounding the heart. - is known as pericarditisInflammation of the sac surrounding the heart (the pericardium).. It is often seen from 2-3 days after a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction..

Pericarditis causes chest pain that may be worse on breathing in. It is frequently accompanied  by a collection of fluid in the pericardiumThe sac surrounding the heart., known as a pericardial effusionAn abnormal collection of fluid around the heart., [1,13] which may cause symptoms such as a cough and shortness of breath. Anti-inflammatory medications and sometimes surgical drainage may be needed.

Structural problems

Structural problems in the heart that may be seen after a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. include damage to the muscles controlling the heart valves, known as papillary muscles, rupture of the ventricleEither of the two lower chambers of the heart, or any of the four cavities within the brain., and rupture of the interventricular septum - the wall that separates the two lower chambers of the heart.

Papillary muscleTissue made up of cells that can contract to bring about movement. damage can prevent one of the valves of the heart, the mitral valveA valve in the heart located between the left atrium (one of the two upper chambers of the heart) and the left ventricle (one of the two lower chambers)., from functioning properly. Emergency surgery may be needed.[14-16]

Stroke

When a piece of heart muscleTissue made up of cells that can contract to bring about movement. dies, a bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clot may form over the surface of the dead muscleTissue made up of cells that can contract to bring about movement.. Sometimes, part of this clot can break off and be carried away in the bloodstream.

This can have several consequences, one of which is that if the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clot is carried to an arteryA blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood. in the brain, it can obstruct bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. flow to a part of the brain, causing a stroke. The number of people having a stroke after a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. seems to be decreasing.[1,17]

Stroke minisite

Heart failure

Heart attacks are often followed by thinning of the affected part of the heart muscleTissue made up of cells that can contract to bring about movement.. This can weaken the wall of the heart and lead to an expansion (known as dilation) of one of the lower heart chambers, the ventricles.

This is called a ventricular aneurysmAn abnormal dilatation in one of the two lower chambers of the heart.: it leads to less efficient pumping of the heart and can result in heart failureFailure of the heart to pump adequately., even years after the heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction.. [1]

Assessing the function of the heart with echocardiographyThe use of ultrasound to examine the heart as it is pumping. is usually a routine check after a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., to look for any signs of impaired pumping action that could lead to heart failureFailure of the heart to pump adequately..[18,19]

Cardiogenic shock

Cardiogenic shock means that bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. does not reach all of the tissues of the body, even though there is enough bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. in the body. It is caused by failure of the heart to pump bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. round the body to the tissues efficiently enough.

There are a number of possible causes of cardiogenic shockA lack of sufficient blood supply to the vital organs due to cardiac pump failure. after a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., including structural heart problems.[15]

References: 
  1. Boon NA, Colledge NR and Walker BR. Davidson's Principles and Practice of Medicine. Churchill Livingstone Elsevier. 2006; 20th edition.
  2. Outcomes of patients in clinical trials with ST-segment elevation myocardial infarctionDeath of an area of heart muscle due to poor blood supply. among countries with different gross national incomes. Orlandini A, Díaz R, Wojdyla D et al. European Heart Journa. 2006;27:527-33.
  3. Blood glucoseA simple sugar that is an important source of energy in the body. and its prognostic implications in patients hospitalised with acuteHas a sudden onset. myocardial infarctionDeath of an area of heart muscle due to poor blood supply.. Kosiborod M. Diabetes Vasc Dis Res 2008;5:269-75.
  4. Acute hyperglycaemiaA high level of glucose in the blood.: a 'new' risk factor during myocardial infarctionDeath of an area of heart muscle due to poor blood supply.. Ceriello A. European Heart Journal 2005;26:328-31.
  5. A systematic review of studies comparing myocardial infarctionDeath of an area of heart muscle due to poor blood supply. mortality for generalists and specialists: lessons for research and health policy. Hartz A and James PA. J Am Board Fam Med 2006;19:291-302.
  6. Independent importance of psychosocialRelating to psychological and social factors. factors for prognosis after myocardial infarctionDeath of an area of heart muscle due to poor blood supply.. Welin C, Lappas G and Wilhelmsen L. Journal of Internal Medicine 2000;247:629-39.
  7. Clinical profile and outcome of first acuteHas a sudden onset. myocardial infarctionDeath of an area of heart muscle due to poor blood supply. with ischemic mitral regurgitation. Chung SY, Lin FC, Chua S et al. Chang Gung Med J 2008;31:268-75.
  8. Nonarrhythmic complications of acuteHas a sudden onset. myocardial infarctionDeath of an area of heart muscle due to poor blood supply.. Emerg Med Clin North Am 2001;19:397-415:xii-iii.
  9. Atrial fibrillation complicating acuteHas a sudden onset. myocardial infarctionDeath of an area of heart muscle due to poor blood supply.: how should it be interpreted and how should it be treated and prevented? Cappato R. European Heart Journal 2009;30:1035-7.
  10. Risk factors for primary ventricular fibrillationAn abnormal heart rhythm causing failure of the lower chambers of the heart (ventricles) to pump properly. Abbreviated to VF. during acuteHas a sudden onset. myocardial infarctionDeath of an area of heart muscle due to poor blood supply.: a systematic review and meta-analysis. Gheeraert PJ, De Buyzere ML, Taeymans YM et al. European Heart Journal 2006;27:2499-510.
  11. Clinical and angiographic importance of right bundle branch blockA block in the normal conduction of electrical activity in the heart. in the setting of acuteHas a sudden onset. anterior myocardial infarctionDeath of an area of heart muscle due to poor blood supply.. Arslan U, Balcioğlu S, Tavil Y et al. Anadolu Kardiyol Derg 2008;8:123-7.
  12. Angina at 1 year after myocardial infarctionDeath of an area of heart muscle due to poor blood supply.: prevalence and associated findings. Maddox TM, Reid KJ, Spertus JA et al. Arch Intern Med 2008;168:1310-6.
  13. Pericarditis after myocardial infarctionDeath of an area of heart muscle due to poor blood supply.. Nemeth MA, Coulter S and Flamm SD. Tex Heart Inst J 2003;30:246-7.
  14. Ventricular septal rupture complicating myocardial infarctionDeath of an area of heart muscle due to poor blood supply.: comprehensive assessment of cardiac coronaryRelating to the arteries supplying the heart itself. arteries, anatomy, perfusion and function by multidetector computed tomography. Ghersin E, Lessick J, Abadi S et al. Can J Cardiol 2008;24:e21-2.
  15. Management of cardiogenic shockA lack of sufficient blood supply to the vital organs due to cardiac pump failure. complicating acuteHas a sudden onset. myocardial infarctionDeath of an area of heart muscle due to poor blood supply.. Menon V and Hochman JS. Heart 2002;88:531-7.
  16. Papillary muscleTissue made up of cells that can contract to bring about movement. rupture complicating an acuteHas a sudden onset. myocardial infarctionDeath of an area of heart muscle due to poor blood supply.. Dias B, Graba J, Siu S et al. Can J Cardiol 2001;17:722-3.
  17. Twenty-year trends in the incidenceThe number of new episodes of a condition arising in a certain group of people over a specified period of time. rates of stroke complicating acuteHas a sudden onset. myocardial infarctionDeath of an area of heart muscle due to poor blood supply.: the Worcester heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. study. Saczynski JS, Spencer FA, Gore JM et al. Arch Intern Med 2008;168:2104-10.
  18. Heart failure post-myocardial infarctionDeath of an area of heart muscle due to poor blood supply.: a review of the issues. Dargie H. Heart 2005;91 (Suppl II):ii3-6.
  19. The timing of development and subsequent clinical course of heart failureFailure of the heart to pump adequately. after a myocardial infarctionDeath of an area of heart muscle due to poor blood supply.. Torabi A, Cleland JGF, Khan NK et al. European Heart Journal 2008;29:859-70.