Undoubtedly, the worst long term effect of Heart disease that is left untreated would be death. But, the long term effects that occur while alive, that lead up to death, might sound better than dying, but it could turn out to be a long, slow process. Enlargement of the heart will occur, as will blood pressure, as the heart will be pumping faster. Blood vessels will become more narrow, and the heart will stop pumping as much blood to areas like the hands and feet, so that more blood can get to vital organs instead.
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