Complications

By Mayo Clinic staff The risk of complications from an enlarged heart depends on the part of the heart that is enlarged and the underlying cause. Complications of enlarged heart can include: Heart failure. One of most serious types of enlarged heart, an enlarged left ventricle, increases the risk of heart failure. Heart failure occurs when your heart can't pump enough blood to meet your body's needs. Over time, the heart can no longer keep up with the normal demands placed on it. The heart muscle will weaken, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body. Blood clots. Having an enlarged heart may make you more susceptible to forming small blood clots in the lining of your heart. If clots are pumped out of the heart and enter your circulatory system, they can block the blood flow to vital organs, including your heart and brain causing a heart attack or stroke. If clots develop on the right side of your heart, they may travel to your lungs, a dangerous condition called pulmonary embolism. Heart murmur. For people who have an enlarged heart, two of the heart's four valves the mitral and tricuspid valves may not close properly because they become dilated, leading to a backflow of blood. This flow creates sounds called heart murmurs. Heart murmurs are not necessarily harmful, but they should be monitored by your doctor. Cardiac arrest and sudden death. Some forms of enlarged heart can lead to disruptions in your heart's beating rhythm. Some of these heart rhythms are too slow to move your blood, and some are too fast to allow the heart to beat properly. In either case, these abnormal heart rhythms can result in fainting or, in some cases, cardiac arrest or sudden death. Complications of heart disease include: Heart failure. One of the most common complications of heart disease is heart failure. Heart failure occurs when your heart can't pump enough blood to meet your body's needs. Over time, the heart can no longer keep up with the normal demands placed on it. The ventricles may become stiff and don't fill properly between beats. Also, the heart muscle may weaken, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body. Heart failure can result from many forms of heart disease, including heart defects, cardiovascular disease, valvular heart disease, heart infections or cardiomyopathy.

Heart attack. Coronary artery disease can cause a heart attack. Heart attacks usually occur when a blood clot blocks the flow of blood through a coronary artery a blood vessel that feeds blood to a part of the heart muscle. Interrupted blood flow to your heart can damage or destroy a part of the heart muscle.

Stroke. Cardiovascular disease may cause an ischemic stroke, which happens when the arteries to your brain are narrowed or blocked and too little blood reaches your brain. A stroke is a medical emergency brain tissue begins to die within just a few minutes of a stroke.

Aneurysm. Cardiovascular disease can also cause an aneurysm, a serious complication that can occur anywhere in your body. An aneurysm is a bulge in the wall of your artery. If an aneurysm bursts, you may face life-threatening internal bleeding. Although this is usually a sudden, catastrophic event, a slow leak is possible. If a blood clot within an aneurysm dislodges, it may block an artery at another point downstream.

Peripheral artery disease. The same atherosclerosis that can lead to coronary artery disease can also lead to peripheral artery disease (PAD). When you develop peripheral artery disease, your extremities usually your legs don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (claudication).

Sudden cardiac arrest. Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness. Sudden cardiac arrest usually results from an electrical disturbance in your heart that disrupts its pumping action and causes blood to stop flowing to the rest of your body. Sudden cardiac arrest almost always occurs in the context of other underlying heart problems, particularly coronary artery disease. Sudden cardiac arrest is a medical emergency. If not treated immediately, it is fatal, resulting in sudden cardiac death.

What Are The Complications Of A Heart Attack?

Last updated on: 29/03/2012 Contributing Author: Guy Slowik FRCS Heart attacks vary widely in the amount of damage caused and whether there are any complications. Some people may suffer a

mild heart attack with no associated complications, which is called an uncomplicated heart attack. Others may suffer a more extensive heart attack with a wide range of complications. Fortunately, treatments can prevent or reduce the impact of complications if they occur. Complications depend on the:

Location of heart muscle damage (i.e. the right or left ventricles) Extent of heart muscle damage Time after the heart attack (i.e., immediate or weeks later) Complications include: Arrhythmias or abnormal heart rhythms Recurrent ischemia or heart attack Heart failure (the failure of the heart to pump adequate blood to meet the body's needs) Blood clot formation Mechanical complications Pericarditis, an inflammation of the sac that surrounds the heart

Arrhythmias (Abnormal Heart Rhythms)

The heart is normally driven by electrical impulses that follow specific pathways through the heart muscle. A heart attack damages heart muscle and often disrupts these electrical pathways. Other stimulation of the body's nervous system and certain heart medications can also disturb the heart's electrical

impulses. These changes cause abnormal heart rates and rhythms, called "arrhythmias."

Need To Know: Some arrhythmias, such as atrial arrhythmias, such as atrial fibrillation or atrial flutter are mild. But others, such as ventricular arrhythmias or complete heart block, are life threatening, occur without warning, and usually happen within the first 24 hours after a heart attack. Arrhythmias are a major cause of death following an acute heart attack. Early defibrillation (applications of electrical shocks to the heart) by rescue workers, combined with early detection and treatment of arrhythmias in coronary care units, have dramatically reduced both pre-hospital and in-hospital deaths caused by abnormal heart rhythms. Both continuous ECG monitoring and standard 12-lead electrocardiograms help to screen for arrhythmias.
Arrhythmias may be treated with:

Medications Electrical cardioversion, which is the application of electric shocks to the heart through the chest wall

Pacemakers, which regulate very slow heart rates due to blocks in the transmission of electrical impulses

Recurrent Ischemia Or Heart Attack

About 20 to 30 percent of heart attack patients experience pain that occurs after the heart attack. Called "postinfarction angina," this indicates that remaining blood flow to the heart muscle is inadequate. These patients are at increased risk for a subsequent heart attack, called reinfarction. About 5 to 20 percent of these patients will experience another heart attack in the first six weeks following the original one. This second event may involve the same region of heart muscle or an entirely new region. Aggressive management of angina following a heart attack helps to reduce the risk of a subsequent heart attack. Patients who experience such angina usually undergo immediate cardiac catheterization and cardiac angiography. This is often followed by

Angioplasty or Coronary artery bypass surgery Both of these invasive procedures restore blood flow to the heart muscle and lower the risk of a subsequent heart attack.

Heart Failure

Damage to heart muscle from a heart attack may leave the heart unable to pump effectively. If 30 percent or more of the heart muscle in the wall of the left ventricle has been affected, it is likely the patient will develop congestive heart failure. These patients may experience shortness of breath because of fluid in lung airways. This is caused by the fact that the heart cannot effectively pump blood forward through the body. This condition can usually be treated effectively with medications but may require cardiac bypass surgery.

Cardiogenic Shock
If 40 percent or more of the left ventricle's muscular wall has been affected, cardiogenic shock may occur. In cardiogenic shock, not enough functional heart muscle remains to pump blood to body tissues and organs to sustain important bodily functions. The heart is not able to provide sufficient blood flow to organs such as the brain, kidneys. As a result, the patient experiences very low blood pressure, rapid heart rate, mental confusion, decreased urine output, and cold arms and legs. Patients with cardiogenic shock are treated with medications that either increase the amount of blood pumped or reduce the pressure the heart is pumping against. Some individuals may receive a device called an intraaortic balloon pump. The pump is inserted into the aorta, the major blood vessel that supplies blood to the body from the heart. Inflation of the pump increases the

blood pressure in the aorta, which, in turn, increases blood flow to the coronary arteries and peripheral (far away) body tissues. Individuals who experience a heart attack involving the wall of the right ventricle may show signs of right heart failure, such as distended neck veins and leg swelling. These individuals are usually treated with medications. In many cases, the best treatment for cardiogenic shock is bypass surgery. For detailed information about bypass surgery, go to Cardiac Bypass Surgery.

Thrombus (Blood Clot) Formation

Erratic blood flow and a lack of blood flow in parts of the heart damaged by the heart attack can cause clots to form in the heart's chambers. This is especially true if the heart attack has involved the tip of the left ventricle or when an aneurysm has formed. Inactivity due to bed rest increases the risk of blood clots forming in the deep veins of the legs. These clots can break off and travel through veins to the lungs, where they may cause a blood clot in pulmonary arteries.

Need To Know: Preventive measures can dramatically reduce the risk of blood clot formation in a heart chamber or blood vessel after a heart attack.

The use of anticoagulants or blood thinners in patients

at high risk for developing blood clots that could travel through the body's arteries Placing elastic stockings on the legs

Mechanical Complications
When a heart attack damages muscle, this can lead to the formation of tears or holes in the heart's wall, which in turn affects heart function. These developments are referred to as mechanical complications. Types of mechanical complications include:

Papillary muscle rupture: the tearing of muscle that attaches to heart valves, which are tissue flaps that direct blood flow through the heart Ventricle free wall rupture: the tearing of the heart muscle wall of the left ventricle, causing blood to fill the fibrous sac that surrounds the heart Ventricular septal rupture: the tearing of the wall between the right and left ventricles, causing blood flow to pass between these heart chambers Aneurysm formation: the dilation or enlargement of a heart chamber due to weakness of its muscular wall These complications are rare, but can cause varying degrees of heart problems and even death. Complications such as ventricular wall rupture may occur within two weeks of the heart attack, while others such as aneurysm formation may happen

weeks or months later. The outcome depends on the degree of damage and swiftness of detection and treatment. Screening for mechanical complications includes:

Watching for signs of heart failure, such as shortness of breath or leg swelling Listening with a stethoscope for new heart murmurs, which would suggest that heart valves are not working properly or that blood is flowing through the wall that divides the ventricles Echocardiography to look at the structure and function of the heart chambers, including blood clots associated with aneurysm formation Electrocardiography to look for electrocardiogram (ECG) changes that may occur with aneurysm formation. Chest x-ray to look for "bulging" of the left ventricle, which would suggest an aneurysm Doctors and other members of the medical team closely monitor patients for such complications. Monitoring continues after patients leave the hospital at follow-up appointments. Tests performed prior to hospital discharge can often determine the potential for such future problems.

Pericarditis
Acute pericarditis, the short-term inflammation of the fibrous sac that encloses the heart, may occur early after a heart attack. Symptoms include pain and fever. A pericardial friction rub may be heard with a stethoscope. This finding is helpful in

distinguishing between pericarditis and angina that is occurring after a heart attack. The increased use of clot buster drugs has decreased the frequency of pericarditis. These medications limit the extent of both heart muscle damage and inflammation. If pericarditis does occur, it can be treated with aspirin.

Read more: http://ehealthmd.com/content/what-arecomplications-heart-attack#ixzz2kgli5Eh2