Structural Heart Disease

Structural heart disease is a problem with the tissues or valves of the heart. Many, structural heart diseases are congenital [con-JEN-it-al], which means present at birth. Some structural heart disease will develop later in life.

There are many kinds of structural heart diseases, but they all involve a defect or disorder in the structure of the heart tissue or valves. Heart conditions that fall in the category of structural heart disease include:

• Aortic [a-OR-tick] valve stenosis [sten-OH-sis]. In this disorder, a valve in the heart, the aortic valve, has narrowed, and can't open all the way.
• Atrial septal defect (ASD) and Patent foramen ovale (PFO). ASDs and PFOs are two types of holes or defects that can occur between the upper two chambers of the heart.
• Heart valve disease. Heart valve disease is when one or more valves in the heart is damaged causing problems with blood flow.
• Mitral valve regurgitation. In this condition, one of the valves in your heart, the mitral valve, lets blood leak backward into the heart.
• Left ventricular hypertrophy. The muscle wall of the left ventricle becomes thickened.
• Cardiomyopathy. This is a term used to describe changes in the heart muscle. In most cases, the muscle becomes stiff and enlarged.
• Marfan syndrome. This is a problems with te bod’s connective tissue. It can cause an aneurysm to form in the aorta or cause problems with the mitral valve.
• Myocarditis. This is when the heart muscle becomes inflamed.

The symptoms of structural heart disease vary depending on the condition and the patient. Most of the time, the symptoms of heart disease will include:

• Mini strokes, also known as transient ischemic attack (TIA)
• Stroke
• Shortness of breath
• Chest pain
• A tight feeling in the chest
• High blood pressure
• Leg cramps
• Kidney dysfunction
• Irregular heart beats
• Extreme tiredness (fatigue)
• Coronary artery disease

If you have heart failure, your symptoms are due to either fluid buildup or lack of oxygen in your tissues. You may notice some — or all — of these heart

failure symptoms:

• Shortness of breath.
• Cough.
• Excessive fatigue.
• Weight gain.
• Swollen ankles, feet, belly, lower back, and fingers.
• Poor concentration and memory lapses. 

If you are having any of the symptoms listed above, make an appointment to see your doctor. Tests may be needed to confirm or rule out a heart condition.

Many times, structural heart disease is the result of a congenital defect, meaning it is something that you are born with. However, sometimes, it is something that can happen over time, such as:

• Atherosclerosis [ath-eh-roe-scler-OH-sis]. The arteries that supply the heart with blood are narrowed or clogged. This condition reduces the amount of oxygen your heart receives and weakens the muscle. It can also cause a heart attack that leaves scar tissue on your heart. Unlike normal heart muscle, scar tissue doesn’t contract so your heart may pump less effectively.
• High blood pressure (hypertension). Long-term, poorly controlled high blood pressure makes your heart work harder to pump blood through your body. This is because high blood pressure increases the resistance your heart must pump against. Over time, all that extra work can wear out your heart and lead to heart failure.
• Heart valve problems. Heart valves control the direction of blood flow through your heart. When they’re damaged, they often don’t open and close properly. This leads to backflow of blood or limits the forward flow of blood. Congenital defects (defects present at birth) and infections such as rheumatic [roo-mat-ick] fever can cause heart valve problems that interfere with your heart’s ability to pump blood effectively. 
• Alcohol abuse. Chronic, excessive alcohol intake can severely weaken the muscle walls of the heart.  
• Drug use. Street drugs such as cocaine or amphetamines can damage the heart. Misuse of some prescription medicines can also cause heart failure.
• Cancer treatments. Rarely, some cancer treatments can damage the heart.

If you were not diagnosed with a congenital heart defect at birth, there are a few different ways that your doctor might diagnose your condition, including a physical exam and asking about your medical history, symptoms, and general health.

Your doctor may recommend additional tests to measure your heart function and determine the cause of your heart problem. Some of these tests may be done more than once to check if your condition changes over time or in response to treatment.

• Blood tests. Blood tests can assess a variety of health factors. These include your red blood cell count and level of electrolytes (important elements like sodium and potassium). Blood tests can also check the function of your kidneys, liver, and thyroid. In some instances, blood tests can identify the cause of your heart problem.
• Urinalysis. Studying a sample of your urine (pee) will help detect any problems with your kidneys or bladder that may be contributing to your heart problem.
• Chest x-ray. An x-ray image of your chest shows the size of your heart and can help determine the presence of fluid buildup in your lungs.
• EKG (ECG, electrocardiogram). This test records the electrical activity of your heart and displays it on a screen for your healthcare providers to study. The procedure involves placing electrical wires with patches on your chest, arms, and legs.
• Echocardiogram (Echo). This is the easiest way to assess the heart’s function. An echo test uses sound waves (ultrasound) to create an image of the structure and movement of your heart. It shows your doctor to see how well your heart is pumping. It also looks at your heart valves and the size of your heart.

Other tests can be used to assess how well your heart is working:

• Imaging tests. A variety of imaging tests involve injecting a special substance into your bloodstream and then taking x-rays. The images show blood flow and the heart’s structure and movement. This helps your providers see how well your heart is pumping.
• Cardiac MRI. This test uses radio waves and strong magnets to create images of your beating heart and blood vessels. While you lie on an exam table surrounded by a large magnet, the test creates many images that are combined to create detailed pictures or movies.
• Right heart catheterization. In this test, a long, thin tube is inserted into a blood vessel, usually in the neck or groin. It is directed into the heart, where the catheter can check pressures in the heart and in the artery, that leads to the lungs. The catheter can also measure heart output and blood oxygen levels.

Your doctor might order tests to look for signs of coronary artery disease.  These tests can include:

• Angiogram. In this test, a catheter is inserted into a blood vessel (usually in the groin area), and threaded through the vessel to the heart. A dye is injected through the catheter and special x-rays can track the flow of blood to your heart muscle.
• Stress test. This test shows your heart’s response to stress. Your heart is stressed by exercise (on a treadmill or stationary bike) or by medication. During this period of stress, your doctor checks your vital signs and monitors your heart’s response using an EKG and other images.

Sometimes, you don’t need any treatment for your structural heart disease, but your doctor will probably want you to get tested regularly to see if your disease changes or gets worse. If treatment is needed, some of the possible treatments might include:

• Prescribe and adjust medicine
• Open or bypass coronary arteries
• Repair or replace heart structures
• Implant cardiac devices
• Replace or assist your heart

Most of the time, structural heart disease is something that you are born with, and there is nothing that you can do to prevent it. However, there are times that it may develop after birth. If this is the case, some things that can prevent structural heart disorder include:

• Prevent atherosclerosis, or clogging of the arteries with lifestyle changes, like eating healthier foods and getting more exercise.
• Manage your high blood pressure by avoiding sodium and taking your medicine.
• Limit your use of alcohol.
• Avoid street drugs. 

Structural heart disease is a problem with the heart tissues or valves. Many structural heart diseases are congenital, which means they were present at birth. Some structural heart disease can develop later in life.