Cardiac arrhythmias
Early complications, which can occur during the first 48 hours after a heart attack, make the immediate post-infarction period the most dangerous for the patient. In 95-100% of cases, cardiac arrhythmias occur after the heart attack, which can range from additional beats of the ventricle to fatal ventricular fibrillation. Atrial fibrillation or a drastic drop in heart rate (bradycardia) can also occur. Early administration of beta-blockers, which stabilize the heart rate, can reduce the risk of ventricular fibrillation and mortality.
Left heart failure
Left heart weakness (left heart failure) occurs in 1/3 of patients with heart attack and is usually present when more than 15-20% of the heart muscle cells of the left ventricle have died. Pump failure of the heart is the second most common cause of death after ventricular fibrillation. Drug therapy relieves the heart by reducing the so-called preload and afterload.
The preload is the stretched state of the left heart before the ventricular contraction (systole/tension of the heart muscle cells) and is co-determined by the filling situation of the venous and pulmonary circulation (cardiovascular system). Nitro preparations are given to reduce the preload. The afterload is decisively influenced by the prevailing blood pressure in the vascular system. To relieve the heart, elevated blood pressure values must be lowered and/or the pumping action of the heart must be improved. To achieve this, ACE inhibitors (blood pressure lowering effect) and/or catecholamines are administered, which increase the cardiac output.
Further complications
As further possible complications of the heart attack are the: to be mentioned.
- Infarction pericarditis (inflammation of the pericardium)
- A tear in the heart wall (rupture of the heart wall) with pericardial tamponade (blood accumulation in the pericardium) and
- Arterial and venous embolisms (diseases caused by blood clots blocking vessels, e.g. pulmonary embolism)
Pericarditis
Pericarditis (inflammation of the pericardium) occurs in 10-15% of infarction patients and the patient becomes aware of it on the 2nd-3rd day after the heart attack due to newly occurring chest pain. This pain lasts for 1-2 days. The tearing of the heart wall (cardiac wall rupture) with subsequent blood leakage is associated with acute symptoms of shock.
The drop in blood pressure and the drop in cardiac output are threatening. During pericardial tamponade, blood accumulates in the pericardium, exerting increased mechanical pressure on the heart chamber. The filling of the ventricle is hindered, so that the stroke volume (the amount of blood ejected by the heart in systole) decreases and the acute state of shock occurs. Patients must undergo surgery immediately to prevent their death.
