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The heart is a muscular pump made up of four chambers: two upper chambers called the atria and two lower chambers called the ventricles. Blood flows into the atria and then down into the ventricles, which are responsible for pumping it out of the heart. The ventricles are the main working chambers of the heart.
The right ventricle pumps blood to the lungs, where it receives oxygen, while the left ventricle pumps oxygen-rich blood to the rest of the body. Because of this, the left ventricle has thicker, stronger muscle than the right, as it needs to generate enough force to circulate blood throughout the entire body. Healthy ventricles are essential for maintaining good circulation and overall heart function. A heart attack, also known as a myocardial infarction, occurs when the blood supply to part of the heart muscle is blocked. This can cause damage to the heart tissue, particularly affecting the ventricles. In some cases, the damaged area may weaken or break down, leading to complications that can affect how well the heart pumps blood.
Ventricular aneurysm
One possible complication after a myocardial infarction is the development of a ventricular aneurysm. This typically develops when part of the heart muscle (typically the left ventricle) that is damaged and replaced by scar tissue, bulges outward under pressure. Unlike healthy heart muscle, this scarred area does not contract properly, so instead of helping to pump blood, it may move abnormally or not move at all. As a result, the heart becomes less efficient at pumping blood around the body. Some people may experience symptoms such as breathlessness, tiredness, or reduced exercise tolerance. In addition, blood can sometimes pool within the bulging area, which may increase the risk of clot formation. These clots can occasionally travel to other parts of the body, potentially causing complications such as stroke. The abnormal movement of the heart wall can also disrupt the heart’s electrical system, increasing the risk of irregular heart rhythms. Treatment depends on the size of the aneurysm and the symptoms it is causing. Many patients are managed with medication to support heart function and reduce the risk of clots. In selected cases, particularly when symptoms are significant or complications develop, surgery such as left ventricular reconstruction may be recommended to remove or exclude the weakened area and improve the heart’s overall function.
Left ventricular reconstruction surgery (LVRS) is a procedure designed to restore the normal shape and function of the heart after damage, often caused by a myocardial infarction. When part of the left ventricle becomes weakened or scarred, it can lose its natural cone shape and become enlarged or distorted, reducing how effectively the heart pumps blood. During this operation, surgeons carefully reshape the left ventricle using specially designed devices, sometimes referred to as “mannequins,” which act as guides to help restore a more natural, cone-like shape while preventing overcorrection. This approach is supported by clinical experience showing that returning the ventricle closer to its normal geometry can improve pumping efficiency and symptoms in selected patients. The procedure is commonly performed alongside other heart operations, such as coronary artery bypass surgery and mitral valve surgery, to address underlying problems with blood flow and valve function at the same time. Because of its complexity, this operation requires specialist expertise in cardiac reconstruction surgery and is typically carried out in centres with experienced multidisciplinary heart teams.
Ventricular Septal Defect (VSD)
Another, less common but serious complication is a ventricular septal defect (VSD). After a heart attack, the damaged tissue between the two ventricles can sometimes rupture, leading to a hole in the wall (septum) that separates the left and right ventricles. This allows blood to flow from the high pressure left side to the lower-pressure right side of the heart, placing extra strain on the heart and reducing its ability to pump blood effectively. Post-heart attack VSDs are often described based on their location within the dividing septum of the heart. Anterior VSDs usually occur after a blockage in the front artery of the heart and tend to affect the front (anterior) part of the septum. Posterior VSDs occur in the lower or back (posterior) part of the septum and are often associated with damage to a different blood supply. The location of the defect can influence both the severity of the condition and the complexity of treatment.
In a small number of patients, the ventricular septal defect can be very small, meaning only a limited amount of blood passes through the hole. This is known as a restricted VSD. Because the effect on the heart is relatively mild, these cases can often be managed with medication and careful monitoring for many years, with patients maintaining a good quality of life. However, in the majority of cases following a myocardial infarction, the defect is larger and allows a significant amount of blood to flow from the high-pressure left ventricle to the lower-pressure right ventricle. This places considerable strain on the heart and lungs, and surgical VSD repair is usually required. In many situations, this is considered urgent, and in some cases, it can be a true cardiac surgical emergency. The most common surgical approach involves closing the hole using a patch, which may be made from synthetic material, the patient’s own tissue, or animal tissue (commonly bovine). The patch is carefully sewn over the defect to stop the abnormal blood flow and restore more normal circulation within the heart. Surgeons use specialised techniques to attach the patch securely to healthy surrounding tissue, helping to ensure a durable repair and reduce the risk of complications. This procedure is commonly performed alongside other heart operations, such as coronary artery bypass surgery and mitral valve surgery, to address underlying problems with blood flow and valve function at the same time. Because these procedures can be technically challenging (particularly for defects located in more difficult areas such as posterior VSDs) treatment requires specialist expertise in cardiac reconstruction surgery. Surgery is therefore typically performed in specialist centres by experienced multidisciplinary heart teams, ensuring patients receive the highest level of care.
Patients who undergo complex repair of a ventricular septal defect, particularly where patches are used inside the heart, will require lifelong blood-thinning medication, most commonly Warfarin. This is because the patch material within the heart can slightly increase the risk of blood clots forming as blood flows over it. Warfarin works by making the blood less likely to clot, helping to protect against serious complications such as stroke or blockage of blood vessels. Patients taking Warfarin will need regular blood tests (INR checks) to make sure the dose is just right (enough to prevent clots, but not so much that it increases the risk of bleeding). Although taking long-term medication may feel daunting at first, most patients adapt well with support from their healthcare team and the use of portable, user-friendly, and accurate handheld devices like CoaguChek. You will be given clear guidance on diet, other medications, and monitoring, allowing you to live safely and confidently while on treatment.
If you have had a heart attack, it is important to be aware of symptoms such as increasing breathlessness, fatigue, chest discomfort, or swelling in the legs. These may indicate that the heart is not functioning as well as it should and should be assessed by a healthcare professional. Early diagnosis and treatment of these complications can help improve outcomes and support recovery.
Cardiac Tumours
Cardiac tumours are rare growths that develop within or around the heart. Understandably, being told that you may have a tumour involving the heart can be worrying, however it is important to know that the vast majority of cardiac tumours are benign, meaning they are not cancerous.
Many are discovered incidentally during routine scans or investigations for unrelated symptoms, while others may present with breathlessness, palpitations, dizziness, chest discomfort, or fatigue. With modern cardiac imaging techniques, these conditions can now be diagnosed accurately and assessed in great detail, allowing treatment to be carefully planned in a safe and timely manner.
Every patient is assessed individually, with treatment tailored to the specific type, size, and location of the tumour, as well as the symptoms it may be causing. In many cases, surgical removal is recommended to prevent complications and restore normal heart function. Cardiac tumour surgery requires specialist expertise, meticulous planning, and a personalised approach to ensure the safest possible outcome while preserving the structure and function of the heart. Using advanced surgical techniques and modern perioperative care, the focus is always on achieving excellent long-term results while providing reassurance, clarity, and support throughout the patient journey.
Cardiac myxomas are the most common type of benign heart tumour and are most frequently found in the left upper chamber of the heart, known as the left atrium. Although non-cancerous, they can sometimes interfere with blood flow through the heart or release small fragments that may lead to stroke-like symptoms.
Patients may experience shortness of breath, dizziness, palpitations, fatigue, or fainting episodes, although some myxomas are discovered before symptoms develop. Once diagnosed, surgical removal is usually recommended and, in experienced hands, is associated with excellent outcomes and a very good long-term prognosis.
Ventricular Assist Devices (VADs) are small mechanical pumps that help the heart move blood around the body when it is too weak to do the job on its own. They are usually placed inside the chest and connected to the heart and blood vessels, taking over part or all of the heart’s pumping function. A VAD doesn’t replace the heart, but it gives it support—helping improve blood flow, reduce symptoms like tiredness and breathlessness, and allow vital organs to get the oxygen they need.
Doctors use VADs in a few different ways depending on the patient’s situation. For some people, a VAD is temporary, giving the heart time to rest and recover (“bridge to recovery”). For others, it helps keep them stable while they wait for a heart transplant (“bridge to transplant”). In cases where a transplant isn’t possible, a VAD can be used long-term (“destination therapy”), helping patients live longer and with a better quality of life. While living with a VAD requires some adjustments (like managing a power source and regular check-ups) many patients are able to return to daily activities with improved energy and comfort.
Ventricular Assist Devices (VADs) after cardiac surgery can also be used for short-term support when the heart suddenly becomes very weak, at the end of the operation. This is sometimes called post-cardiotomy shock. In this situation, the heart may struggle to pump enough blood around the body. A temporary VAD can step in and take over some of this work, helping to keep blood flowing to vital organs like the brain and kidneys. This gives the heart a chance to rest and recover. For many patients, this support is only needed for a short time (days or weeks) until the heart becomes stronger again, and then the device can be removed.
Temporary VADs can also be used during complex procedures to treat blocked heart arteries, such as advanced stent implantation for severe or complicated coronary artery disease. In these cases, doctors may need to work on multiple or very narrowed arteries, which can put extra strain on the heart during the procedure. A VAD helps by supporting blood circulation the whole time, so the heart doesn’t have to work as hard. This allows doctors to carry out these high-risk procedures more safely and thoroughly, giving patients access to treatments that might otherwise be too dangerous without this extra support.
In the UK, care for patients with VADs is delivered by highly trained specialist teams and is closely linked to dedicated heart transplant and VAD centres. Even when a patient is treated at a cardiac surgical unit that does not perform transplants, their care is still supported and guided by these expert centres to ensure the highest levels of safety and expertise. This means that decisions about starting, managing, and removing a VAD are made with input from teams who use these devices regularly, giving patients access to expert advice, careful monitoring, and the best possible outcomes.
Dual pacemakers and cardiac resynchronisation therapy (CRT) are treatments that help improve how the heart beats and pumps in people with heart failure, particularly when the heart’s electrical system is not working properly. This is a method by which altering the way electricity is conducted across the heart can improve how effectively it pumps, helping patients feel less breathless and improving overall quality of life. A dual pacemaker works by coordinating signals between the upper and lower chambers of the heart, while CRT (also called biventricular pacing) goes further by synchronising both sides of the lower chambers so they contract more efficiently together. Resynchronisation therapy usually involves implanting a pacemaker using a minimally invasive (percutaneous) procedure, where thin wires are guided through veins into the heart. In some cases, if this approach is not possible, a surgeon may place the wires directly onto the heart using a small incision through the breastbone (mini sternotomy) or keyhole surgery from the side of the chest. Evidence shows that, in suitable patients, CRT can improve symptoms, reduce hospital admissions, and in some cases help people live longer.
