What happens in the heart after a heart attack
A heart attack occurs when a blockage in a coronary artery stops blood flow to an area of the heart muscle and cells die. In the following weeks, inflammation develops at the site of necrosis, dead cells are removed, and dense connective tissue takes their place. This is how a scar is formed, which doctors call post-infarction cardiosclerosis. The remaining healthy muscle takes on additional load, and the left ventricle can change shape and expand - a process called remodeling. Its severity largely depends on the timeliness of treatment of the heart attack and subsequent therapy.
- Small focal cardiosclerosis - small scars
- Large-focal - after a massive heart attack
- With preserved contractility of the left ventricle
- With reduced ejection fraction
- With left ventricular aneurysm
- With rhythm and conduction disorders
Causes and risk factors for complications
The immediate cause of cardiosclerosis is a previous heart attack, and a heart attack is atherosclerosis of the coronary arteries. The factors that led to the first heart attack continue to operate after it, if they are not controlled. Smoking, elevated LDL cholesterol, hypertension, diabetes mellitus, obesity and inactivity accelerate the progression of atherosclerosis. The risk of complications is higher with an extensive scar, low ejection fraction, repeated heart attacks, and chronic kidney disease. Self-discontinuation of antiplatelet drugs and statins is one of the common causes of recurrent cardiovascular events.
- Smoking
- High LDL cholesterol
- Arterial hypertension
- Diabetes mellitus
- Obesity and inactivity
- Stopping taking prescribed medications
- Chronic kidney disease
Symptoms
Manifestations depend on the size of the scar and the condition of the coronary arteries. If cardiac function is preserved, there may be no complaints. With reduced contractility, chronic heart failure develops: shortness of breath on exertion, then at rest, fatigue, swelling of the legs, the need to sleep on a high pillow. Scar tissue creates conditions for arrhythmias, which are manifested by interruptions, palpitations, dizziness, and sometimes fainting. If atherosclerosis progresses, angina returns - pressing pain behind the sternum during exercise. Some arrhythmias are life-threatening, so fainting requires urgent evaluation.
- Shortness of breath on exertion or at rest
- Fatigue and weakness
- Swelling of the legs
- Interruptions and heart palpitations
- Pressing chest pain on exertion
- Dizziness and fainting
Diagnostics
On the ECG after a heart attack, scar changes often remain, which help the doctor assess the location of the lesion. Echocardiography shows the size of the chambers, zones of impaired contractility, left ventricular ejection fraction, the presence of an aneurysm and blood clots, and the condition of the valves. Holter monitoring detects rhythm disturbances and ischemic episodes. The lipid spectrum, glucose, creatinine, potassium are regularly monitored, and if heart failure is suspected, natriuretic peptide is monitored. Stress tests, CT coronary angiography or coronary angiography are needed when angina returns and to resolve the issue of restoring blood flow.
- ECG
- Echocardiography
- Holter ECG monitoring
- Lipid spectrum, glucose, creatinine
- NT-proBNP
- Load tests
- Coronary angiography according to indications
Treatment and rehabilitation
Scar cannot be converted back into muscle, so the goal of treatment is to protect the remaining myocardium and prevent re-infarction. The cardiologist prescribes antiplatelet agents, statins to lower cholesterol to the target level, and drugs that reduce the load on the heart and slow down remodeling. For heart failure, modern groups of drugs that have been proven to prolong life are used. For dangerous arrhythmias and low ejection fraction, implantation of a cardioverter-defibrillator is considered. If ischemia persists, stenting or bypass surgery is performed. The most important role is played by cardiac rehabilitation, smoking cessation, dosed physical activity and blood pressure control.
- Taking prescribed medications daily without interruption
- Cardiac rehabilitation program
- Complete smoking cessation
- Control of blood pressure, cholesterol and sugar
- Salt restriction and weight control
- Annual flu vaccination
- Regular visits to a cardiologist
