1 October, 2024

Understanding Structural Heart Disease: What You Need to Know By Dr. Dhamodaran K,

When you hear the term “heart disease,” it often brings to mind blocked arteries or heart attacks. However, heart disease encompasses a broader range of conditions, and one lesser-known but equally critical type is structural heart disease.

Structural heart disease refers to defects or malfunctions in the heart’s structure, including the tissues, chambers, and valves. These structural abnormalities can impact how your heart functions, affecting your overall health and quality of life. At our cardiology practice, understanding and treating structural heart disease is a priority, as it often requires specialized care.

In this blog, we will explore what structural heart disease is, the different types, symptoms to watch for, and how it is diagnosed and treated. We will also address frequently asked questions to give you a comprehensive understanding of this condition.

What Is Structural Heart Disease?

Structural heart disease is a form of heart disease that affects the anatomy of the heart. While most people associate heart disease with coronary artery disease (CAD), which involves the narrowing or blockage of blood vessels, structural heart disease is quite different. It involves abnormalities in the physical structure of the heart—such as the valves, chambers, or tissues—that impede its ability to function efficiently.

Many cases of structural heart disease are congenital, meaning they are present at birth. However, structural abnormalities can also develop later in life due to wear and tear, other medical conditions, or age-related degeneration. With the advancement of technology and medical science, many structural heart conditions can be treated with minimally invasive procedures, allowing patients to lead healthier lives.

Types of Structural Heart Disease

There are various types of structural heart diseases, each with its own causes, symptoms, and treatments. Below are some of the most common forms of structural heart disease:

1. Aortic Valve Stenosis

Aortic valve stenosis occurs when the aortic valve narrows, restricting blood flow from the heart to the rest of the body. This condition forces the heart to work harder to pump blood, which can lead to heart failure if not treated.

2. Hypertrophic Cardiomyopathy (HCM)

Hypertrophic cardiomyopathy is a genetic condition where the heart muscle thickens, making it harder for the heart to pump blood. It is one of the leading causes of sudden cardiac death in young athletes.

3. Atrial Septal Defect (ASD)

This is a hole in the wall (septum) between the heart’s upper chambers (atria). It can be present at birth and can result in abnormal blood flow between the atria, leading to complications like heart failure if not treated.

4. Mitral Valve Prolapse (MVP)

Mitral valve prolapse occurs when the mitral valve does not close properly, allowing blood to flow backward into the left atrium. In severe cases, this can lead to mitral valve regurgitation, where blood leaks in the wrong direction.

5. Patent Foramen Ovale (PFO)

Similar to ASD, PFO is a small, flap-like opening in the heart that did not close properly after birth. While it often causes no symptoms, it has been associated with strokes and other cardiovascular problems.

6. Left Ventricular Hypertrophy

This condition involves the thickening of the left ventricle’s walls, usually due to high blood pressure. Over time, it can lead to heart failure if left untreated.

7. Tricuspid Valve Regurgitation

In this condition, the tricuspid valve does not close properly, causing blood to flow backward into the heart’s right atrium. This can lead to heart enlargement and failure if untreated.

8. Myocarditis

Myocarditis refers to inflammation of the heart muscle, often caused by infections or autoimmune diseases. It can weaken the heart, leading to arrhythmias or heart failure.

Symptoms of Structural Heart Disease

The symptoms of structural heart disease vary based on the type and severity of the condition. Some individuals may experience no symptoms at all, while others may encounter significant issues that affect their daily lives. Common symptoms include:

• Shortness of breath
• Chest pain
• Fatigue or weakness
• Irregular heartbeats (arrhythmias)
• Swelling in the legs, ankles, or feet
• Dizziness or fainting
• High blood pressure
• Stroke-like symptoms, such as sudden numbness or weakness

If you experience any of these symptoms, especially if you have a family history of heart disease or other risk factors, it is essential to consult a cardiologist for a thorough evaluation.

Causes and Risk Factors

Structural heart disease can be congenital (present at birth) or acquired later in life. Some of the main causes and risk factors include:

• Congenital defects: Conditions such as ASD and PFO are present from birth and may or may not cause symptoms until later in life.
• Age: As you age, the wear and tear on your heart can lead to conditions like aortic stenosis or mitral valve prolapse.
• High blood pressure: Elevated blood pressure can cause left ventricular hypertrophy and increase the risk of other heart conditions.
• Infections: Myocarditis can be caused by viral infections that affect the heart muscle.
• Family history: Some forms of structural heart disease, such as hypertrophic cardiomyopathy, are inherited.

Diagnosis of Structural Heart Disease

Diagnosing structural heart disease typically involves a combination of physical examinations, medical history reviews, and advanced imaging tests. Some common diagnostic tools include:

• Echocardiogram: An ultrasound of the heart that helps visualize the heart’s structure and detect abnormalities.
• Electrocardiogram (ECG): A test that measures the electrical activity of the heart and can detect arrhythmias or other issues.
• Cardiac MRI: This imaging test provides detailed images of the heart and is useful in diagnosing complex structural issues.
• Stress Tests: These tests evaluate how well your heart works during physical activity and can uncover symptoms not present at rest.
• Catheterization: In some cases, a catheter is inserted into the heart to measure pressures and evaluate the condition of the heart’s chambers and valves.

Treatment Options for Structural Heart Disease

Treatment for structural heart disease depends on the type and severity of the condition. Some patients may require regular monitoring and lifestyle changes, while others may need more advanced treatments. Here are some common treatment options:

1. Medications

Many structural heart conditions can be managed with medications to help regulate blood pressure, heart rhythm, and other functions. For example, beta-blockers, ACE inhibitors, or diuretics may be prescribed to control symptoms and prevent complications.

2. Minimally Invasive Procedures

Advances in medical technology have made it possible to treat many forms of structural heart disease with minimally invasive procedures. These include:

• Transcatheter Aortic Valve Replacement (TAVR): Used to treat aortic valve stenosis by replacing the damaged valve without open-heart surgery.
• MitraClip Procedure: A device that clips the mitral valve to reduce regurgitation without the need for surgery.

3. Surgical Options

For more severe cases, traditional open-heart surgery may be necessary to repair or replace damaged valves, close holes in the heart, or address other structural issues.

Living with Structural Heart Disease

Living with structural heart disease requires ongoing care and attention to maintain your heart health. Patients are advised to:

• Follow a heart-healthy diet: Eat foods low in saturated fats, sodium, and cholesterol to reduce strain on the heart.
• Exercise regularly: Engage in moderate physical activity, but consult with your doctor before starting any new exercise regimen.
• Monitor your health: Keep track of any symptoms or changes in your condition and schedule regular check-ups with your cardiologist.
• Take medications as prescribed: Adherence to your prescribed treatment plan is critical for managing symptoms and preventing complications.

FAQs About Structural Heart Disease

1. Can structural heart disease be cured?

In many cases, structural heart disease cannot be cured, but it can be managed effectively with medications, procedures, or surgery to prevent complications and improve quality of life.

2. Is structural heart disease the same as coronary artery disease?

No. While coronary artery disease affects the blood vessels that supply the heart, structural heart disease involves defects or abnormalities in the heart’s structure, such as the valves or chambers.

3. What is the most common type of structural heart disease?

Aortic valve stenosis is one of the most common types of structural heart disease, especially in older adults.

4. What are the symptoms of structural heart disease?

Symptoms vary but may include shortness of breath, chest pain, fatigue, dizziness, and irregular heartbeats.

5. How is structural heart disease diagnosed?

It is diagnosed through various tests, including echocardiograms, electrocardiograms, and cardiac MRIs.

6. Can lifestyle changes help manage structural heart disease?

Yes. A heart-healthy diet, regular exercise, and avoiding smoking or excessive alcohol can help manage the condition.

7. When should I see a cardiologist?

If you experience symptoms like chest pain, shortness of breath, or irregular heartbeats, or if you have a family history of heart disease, it is important to consult a cardiologist.