Beyond the murmur: What structural heart disease really means

Article Summary

Structural heart disease affects the heart's valves, walls, or muscles, often developing quietly over time. Discover common warning signs like shortness of breath and fatigue, key risk factors, noninvasive diagnostic tests, and modern, minimally invasive treatment options.

You go to the doctor for a routine annual checkup feeling completely fine. Your doctor listens to your chest with a stethoscope and hears a faint heart murmur.

Discoveries like this are surprisingly common and can often be attributed to something harmless. But sometimes a newly detected murmur in an adult, especially an older adult, may be a sign of a structural heart issue.

Structural heart disease is common and increases in prevalence with age. For example, more than 10% of adults over age 75 have moderate or severe heart valve disease, one of the most common forms of structural heart disease.

Structural heart disease is a defect or disorder in the heart's structure that makes it difficult for the heart to pump blood efficiently and can lead to serious complications like heart failure, stroke or abnormal heart rhythms if left unmanaged.

"Structural heart disease is more common than most people realize, and much of it develops quietly over years. Some people are born with it, but many develop it with age. The encouraging part is that it can be accurately diagnosed with readily available imaging tools such as an ultrasound of the heart, and the earlier we find it, the more effective therapies can be," said Maen Nusair, MD, an interventional and structural cardiologist at Endeavor Health.

What is structural heart disease?

Structural heart disease is a problem with the heart's valves, chambers, walls or muscle tissue not related to blockages in coronary arteries or heart rhythm problems. These structural changes directly affect how blood moves through your heart and out to the rest of your body.

Three common categories of structural heart issues include:

• Cardiomyopathy: A disease of the heart muscle that affects its ability to pump or to relax and fill with blood.
• Congenital heart disease: A structural issue that is present from birth, such as an atrial septal defect (a hole in the wall separating the upper heart chambers).
• Heart valve disease: A problem with one or more of the four heart valves, such as aortic stenosis (valve narrowing) or mitral valve regurgitation (leaky valve).

What are symptoms of structural heart disease?

Because structural heart disease interferes with your heart's ability to circulate blood to the rest of your body, it can impact your stamina during physical activity or make you feel short of breath. Since these vague symptoms often overlap with things like poor sleep or stress, they are easily overlooked.

"These conditions often progress slowly, so people adapt without realizing it. They stop taking the stairs, slow their walking pace, or give up an activity and chalk it up to getting older. Fatigue or breathlessness that's new or gradually worsening is a reason to get checked, not something to accept as normal aging," said Dr. Nusair.

Common warning signs of a structural heart issue include:

• Shortness of breath during routine activities or when lying flat
• Unexplained fatigue and decreased stamina
• Dizziness, feeling lightheaded, or fainting
• Chest pain, tightness or discomfort
• Heart palpitations or a sensation of an irregular heartbeat
• Swelling in the legs, ankles or feet

Am I at risk for structural heart disease?

Structural heart disease can affect people of all ages. Factors that can raise your risk include:

• Older age (particularly 75 and older)
• Family history of congenital or structural heart issues, such as bicuspid aortic valve
• High blood pressure
• Coronary artery disease or a history of a heart attack
• Diabetes or chronic kidney disease
• Atrial fibrillation
• Certain infections or their complications, such as rheumatic fever (a complication of untreated strep throat) or endocarditis
• Prior radiation therapy to the chest

How is structural heart disease diagnosed?

While many congenital heart defects are detected at or near birth, acquired structural heart disease can develop silently over time. Knowing your family health history is vital, as some heart conditions run in families.

"Many adults find out they have a structural heart issue during a routine physical exam or imaging test for unrelated concerns," said Dr. Nusair.

If your doctor suspects a structural issue, diagnostic testing may include:

• Echocardiogram: An ultrasound that shows the heart's structure, including heart valves, and how well the heart pumps. This is usually the first and most important test.
• Electrocardiogram (ECG or EKG): A quick test that records the heart's electrical activity and can offer clues about an underlying problem.
• Cardiac CT or MRI: Detailed images of the heart that help confirm a diagnosis and plan treatment.
• Cardiac catheterization: A procedure that uses a specialized flexible tube to measure pressures inside the heart and check for blockages in the coronary arteries.

What is the treatment?

Many mild structural conditions can be safely monitored over time without requiring immediate intervention.

When treatment is needed, the best option is typically decided by a team of heart specialists based on the specific type and severity of the condition and the patient's overall health.

Management options include:

• Medications: Medications can be used to help manage symptoms or complications, such as diuretics, blood pressure medicines, or medications proven to help weak heart muscle get stronger.
• Minimally invasive catheter procedures: Transcatheter therapies, such as valve repair or replacement, typically performed through a small puncture in the groin, can offer faster recovery than open surgery.
• Surgical intervention: Traditional surgery, such as repair or replacement of damaged heart valves, may be the recommended treatment for some patients.

Know your body

It's important to pay attention to changes in your energy levels or your ability to enjoy activities you once loved.

"If you're getting short of breath or tired doing things that used to be easy, don't wait for it to get worse. You know your body best, and a change in your ability to be active deserves attention. Your doctors will guide you to the treatment that's best for you, and we now have well-established, less invasive catheter-based options that can avoid open-heart surgery," Dr. Nusair added.