Heart attack: Aftereffects and recovery

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The damage that occurs in the heart during a heart attack can lead to aftereffects directly due to low oxygen, such as continuing chest pain. A heart attack may also cause arrhythmias, which are irregular heart rhythms, as well as mechanical problems such as:

• heart failure
• cardiogenic shock
• heart rupture

Other possible aftereffects include blood clots and pericarditis, which is swelling of the sac-like tissue surrounding the heart.

Read more about heart attacks.

An arrhythmia may manifest as a fast, slow, or irregular heartbeat. When this happens, the heart pumps less effectively.

If the arrhythmia is mild, it may produce symptoms such as chest pain or palpitations and the sensation of the heart fluttering or pounding.

However, an arrhythmia can be life threatening. A type that is a common cause of sudden death after a heart attack is ventricular tachyarrhythmia. This happens when the lower chambers of the heart — the ventricles — beat too fast, which results in the body not receiving enough oxygenated blood.

Read more about arrhythmia.

Heart failure is the inability of the heart to pump enough blood to the body. It usually occurs on the left side of the heart. When this happens, the tissues do not get enough oxygen, which can cause trouble breathing when lying down and shortness of breath during everyday activities.

A 2020 review reports that heart failure is a frequent complication of a heart attack. In fact, a heart attack is the most common cause of heart failure. Heart failure can occur at the time of the heart attack, during hospitalization, or after hospitalization. Heart failure has a significant negative effect on the outcome of a heart attack.

Read more about heart failure.

In cardiogenic shock, or cardiac shock, the heart suddenly cannot pump enough blood to the brain and other essential organs. It is a life threatening emergency that can manifest as a drop in blood pressure, a slow pulse, and possibly a loss of consciousness.

According to a 2019 review, cardiogenic shock is the top cause of death for people after a heart attack and affects 5–10% of cases. The 6- to 12-month death rate is approximately 50%.

Read more about cardiogenic shock.

A heart rupture is the breaking open of heart tissue. It can occur in the wall of the heart, in the wall that separates the two ventricles, or in the muscles inside the ventricles.

In an older 2002 review, researchers explored the cause of sudden death after a heart attack in 153 people. They found that heart rupture was present in 30.7% of those people.

People with an impending heart rupture after a heart attack frequently complain of chest pain, although they have nonspecific EKG changes. Because the symptoms may be nonspecific or overlap with symptoms of other diagnoses, doctors may miss this diagnosis. Survival depends on quick recognition and immediate treatment.

Read more about heart rupture.

Emergency treatment for a heart attack includes:

• aspirin to prevent more blood clots from forming
• nitroglycerin, which widens blood vessels, improves blood flow through heart arteries, and helps relieve chest pain
• thrombolytic drugs, or clot busters, such as streptokinase (Streptase), which dissolve blood clots that are blocking heart arteries

If blood oxygen levels are low, oxygen therapy is a part of the treatment. It delivers oxygen through a tube in the nose, a facial mask, or a tube in the windpipe.

Additionally, treatment may include one or more of the below procedures:

• Percutaneous coronary intervention (PCI): Also called coronary angioplasty, PCI is a minimally invasive procedure that opens heart blood vessels with a partial or complete blockage. This involves the insertion of a small mesh tube called a stent.
• Coronary artery bypass grafting: This surgery redirects blood around narrowed arteries to improve blood flow and oxygen to the heart.

Most people survive a first heart attack and enjoy many more years of life. While rest during recovery is important, it is also beneficial to participate in social activities and recreation. Most people can return to work within 2 weeks to 3 months.

Doctors recommend participating in a cardiac rehabilitation program to maximize recovery. This includes medically supervised exercise training, counseling to reduce stress, and education in heart-healthy living.

Recovery also involves making the following lifestyle changes:

• quitting smoking, if applicable
• maintaining a nutritious diet
• getting regular physical activity if not in cardiac rehabilitation

Additionally, a doctor may recommend medications and, in some cases, surgery.

Heart attacks have a 5–30% mortality rate. Most of the deaths happen before arrival at the hospital. Also, within the first year after a heart attack, people have a death rate of 5–12%.

The American Heart Association advises the following to help prevent another heart attack:

• Attend follow-up medical appointments.
• Follow healthcare professionals’ directions for taking medications.
• Take part in cardiac rehabilitation.
• Seek support from family members or other people who have had a heart attack.
• Manage any necessary risk factors, such as high cholesterol, high blood pressure, and diabetes.

Aftereffects of a heart attack may include arrhythmias, heart failure, cardiogenic shock, and heart rupture. Some of these are serious complications that can be life threatening.

Immediate heart attack treatment may involve medications, oxygen, and procedures that help restore blood flow.

Most people survive a first heart attack and can eventually return to work. A doctor may recommend lifestyle changes, medications, or surgery to prevent additional heart attacks.

Prevention measures also include getting support from others and managing risk factors such as high blood pressure.