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Complications of myocardial infarction

A heart attack can proceed in many ways. It ranges from "silent" infarcts in which the patient does not notice any discomfort, bouts of severe pain and difficulty in breathing, and sudden death. In between these extremes occur less and major complications that can accompany a heart attack.

What injuries occur on the heart by a heart attack?
When a heart loses a part of the heart muscle's blood supply and thus the oxygen supply. Without oxygen the cells die and the tissue in this area - this is called an infarct. The extent and location of the damaged tissue depends on how much of the coronary artery (artery crane) as clogging, and where the heart this vein is located. A condensation far out in the thinner parts of the coronary artery causes less damage than condensation in the first parts of the coronary artery before it split into smaller branches. Sometimes the infarct whole thickness of the heart wall, sometimes only part of the heart wall destroyed.

When a portion of the heart muscle dies replaced this portion with so-called connective tissue (scar tissue). This is the tissue that lacks hjertemuskulaturens ability to contract, it is a passive tissues. It keeps the heart close, but it does not contribute to the contractions. Therefore weakened heart after a heart attack. The degree of deterioration depends on the extent of the damage. For this reason it is important that treatment is started quickly so the size of the infarction may be limited.

The extent and location of the damage (infarction) of heart muscle determines the complications that may arise.

Cardiac arrythmias

The heart's electrical system
The heart is controlled by electrical impulses. These impulses starting from a point in the right atrium ("sinus node") and the following electrical wire paths to the rest of the heart. The main line passes through the wall between the atria and ventricles ("AV node"), down the wall dividing the left and right ventricle and then into the muscle tissue in all parts of the heart.

Damage to the heart muscle may also affect parts of the electrical wiring of the heart. This can lead to various forms of disturbances in heart rhythm ( arrhythmia ). At worst, it can provide a complete stop in the electrical signals, which leads to cardiac arrest and death if you do not get heart started again. The connection between the chamber and the main chamber can be destroyed ( AV block ). This leads to abnormally slow heart activity, a complication that may require urgent treatment. The damage can also cause other areas of the heart than the sinus node starts sending out pulses, which leads to extra stroke ( extrasystoles ) optionally series with abnormal, rapid stroke ( supraventricular tachycardias and ventricular tachycardias ) or permanent atrial fibrillation . Some of these rhythm disorders are life-threatening, but most are harmless.

Heart Failure
The greater part of the heart that is damaged, the weaker the heart. It may be difficult for the heart to be able to pump away all the blood flowing back to the heart. Blood can thus accumulate in respectively the large body circuit and the small pulmonary circulation, or both - it exists as heart failure . Since it is often the case that only a portion of the heart is weakened, eg. musculature of the left ventricle, so it can be side difference in cardiac pump function. Failure of the muscles in the left side of the heart can cause left ventricular failure, which causes the blood to accumulate in the pulmonary circulation (pulmonary). Failure of the muscles in the right side of the heart may provide right heart failure, which causes the blood to accumulate in the large circulation.

Since the left-sided heart failure leads to increased blood flow (and hence flow rate) in the lungs, it can cause breathing problems because the lungs "filled with water". Failure of the right hand, for example. give swollen legs.

A heart failure may occur acutely during the first minutes after the infarction occurred before gradually slide over. However, heart failure may also be chronic if a sufficiently large portion of the heart muscle is damaged.

Other complications
A relatively rare complication occurs when damage to the heart muscle is so extensive that rips the heart (myocardial). It bleeds out into the pericardium, and death occurs usually pretty quickly. Sometimes the weakened area of ​​the heart "bulge", it has formed a bulge (aneurysm). Besides weakening the heart, an aneurysm predispose to thrombus formation and it may crack. In many cases, they recommend to operate past such aneurysm.

The first few days after a heart attack can cause an inflammatory reaction in the pericardium ( pericarditis ). The condition is characterized by chest pain. Your doctor can by listening with a stethoscope sometimes hear a "squeaking" and ECG may show typical changes.

Since a heart attack means that the areas of the heart just passively included in the movements, increased risk of turbulence in blood flow, which predispose to thrombosis (thrombus). Blood clots that form in the heart, can loosen and come with blood flow (called an embolus) and can block blood vessels elsewhere. A clot from the right side of the heart can block a pulmonary artery ( pulmonary embolism ), while a blood clot from the left side for example. can block an artery in the brain and cause a stroke . In technical terms this is referred to as thromboembolic complications.

Post Infarction Syndrome is an immune reaction occurring in 1-4% of patients 2-12 weeks after an acute myocardial infarction. The patient develops inflammation of the pericardium (pericarditis) and lung bag (pleurisy) because the antibodies. The condition causing pain, fever, increased white blood cells in the blood and high blood erythrocyte sedimentation rate (ESR).

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