Structural Heart Disease
Structural Heart Disease Overview
Structural heart disease describes a condition in which a patient has inherited (congenital) or acquired defects or both, compromising the integrity of the heart’s valves or chambers. These can range from a hole between the top two chambers, as in atrial septal defect or patent foramen ovale; valvular heart disease, such as aortic stenosis/regurgitation or mitral stenosis/regurgitation; or closure of certain pockets of the upper chambers.
Two forms of congenital heart disease include the larger and more complicated atrial septal defect (ASD), or a smaller hole in the wall between the two upper chambers of your heart, a patent foramen ovale (PFO). Both of these deficits can lead to clinical consequences, which may include stroke or right heart failure.
Valvular heart disease occurs when your heart’s valves do not work correctly, characterized by either damage or a defect in one of the four heart valves or supporting apparatus.
The mitral and tricuspid valves control the flow of blood between the upper chambers (atria) and the lower chambers (ventricles). The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve regulates blood flow between the heart and the aorta. Failure of normal mitral and aortic valve function may occur insidiously over many decades.
Valves function normally when blood flows with proper force and direction through the heart. Valvular heart disease is characterized by a valve that is too narrow (stenosis) or when valves are unable to close completely, thus allowing the blood to leak backward across the valve (incompetency, insufficiency or regurgitation). In general, valvular heart disease causes the heart to work harder to circulate the proper amount of blood throughout the body.
Structural heart disease has a variety of causes, some present at birth (congenital) and others acquired later in life. High blood pressure, atherosclerosis , heart attacks, cardiomyopathy and aging may severely affect the heart and valves as well as some migraine and diet medications. Some infections and disorders that may lead to heart disease include:
- Rheumatic fever, in which a streptococcal bacteria affects the mitral valve, causing it to become narrowed (most often) or leaky. Mitral Stenosis is seen much less frequently than in prior decades.
- Endocarditis, a potential life-threatening infection in which bacteria attaches to the heart valves, destroying the valve and leaving scar tissue behind. These germs most often enter the body through improper sterilization during surgery or through poor dental hygiene.
- Carcinoid tumors, rheumatoid arthritis, lupus or syphilis.
Other causes include myxomatous degeneration, which is a weakening of valve tissue caused by connective tissue changes; calcific degeneration, which involves valves thickening due to a buildup of calcium on the aortic or mitral valves; and congenital defects involving an irregularly shaped aortic valve or narrowed mitral valve.
Symptoms
Many patients do not exhibit symptoms in the early stages of structural heart disease, but signs can occur suddenly and increase in severity as the disease develops. Many of the symptoms are similar to those related to congestive heart failure, such as shortness of breath even with limited activity and swelling of the feet, ankles, hands or abdomen.
The main sign of valvular heart disease is an unusual heartbeat sound called a heart murmur. Other symptoms include:
- Rapid or irregular heartbeat or pulse.
- Dizziness or fainting (with aortic stenosis).
- Fever (with endocarditis).
- Rapid weight gain.
Risk Factors
Scientists do not know for certain why congenital heart disease occurs, but it tends to run in families and often occurs with other genetic problems, such as Down’s syndrome. Some conditions during pregnancy may also increase the risk, most notably a rubella (German measles) infection or alcohol and drug use.
Older people are most at risk of developing valvular heart disease, based on estimates that 1 of 8 people aged 75 or older will suffer at least a moderate form of the condition. Also, people who have a history of endocarditis, rheumatic fever, heart attack or heart failure are more at risk. High blood pressure, high cholesterol, smoking, diabetes, obesity, lack of physical exercise and a family history of heart disease are other major risk factors.
Structural Heart Disease Prevention
In most cases, inherited forms of structural heart disease cannot be prevented. If you have a family history of heart defects or genetic disorders, you should consider talking with a Wellstar physician before becoming pregnant.
A major step in preventing the acquired forms of structural heart disease is to get prompt treatment for a sore throat that lasts longer than 48 hours, especially if it is accompanied by a fever. Timely administration of antibiotics can prevent the development of rheumatic fever, which can lead to valvular heart disease. A heart healthy lifestyle and good dental care can also prevent the factors that can lead to valvular heart disease.
Reduce Your Risk of Structural Heart Disease
You might not be able to reduce your risk of inherited forms of structural heart disease, but you can reduce the risks in future generations if you discuss any family history of heart defects or genetic disorders with your doctor.
You can lower your chances of valvular heart disease through several methods:
- Seek proper treatment for a sore throat.
- Don’t smoke or drink alcohol.
- Eat healthy foods and reduce sodium intake.
- Exercise as recommended by your Wellstar physician.
- Control certain physical conditions, including high blood pressure, high cholesterol and diabetes.
- Maintain proper dental hygiene
Tests and Screenings
In diagnosing for structural heart disease, your Wellstar physician will take a careful medical history and perform a physical examination. Through a physical examination, your physician can determine if you have a heart murmur or other signs of the disease, such as fluid around the lungs an irregular heartbeat or fluid build-up in your legs or abdomen.
Based on the exam, your physician might order some of these tests:
- Chest X-ray to reveal fluid build-up in the lungs or calcium deposits in your heart.
- Blood tests to check your kidney and thyroid functions or for diseases that could affect the performance of your heart.
- Electrocardiogram (ECG) to record the electrical activity of your heart and to reveal if there are rhythm abnormalities.
- Echocardiogram, an ultrasound test, designed to show the pumping performance of your heart, a measurement known as the ejection fraction. In a healthy heart, the ejection fraction is about 55%, which means that just over half of your blood filling the ventricle with each cardiac cycle is pumped out with each beat.
- Cardiac Stress Tests, which measure your hearts performance during exertion
- Coronary Catheterization or angiogram in which a thin, flexible tube (catheter) is inserted into your groin or arm and guided through the aorta into your heart. Dye is injected through the tube for fluoroscopic visualization.
- Cardiac Computerized Tomography (CT) Scan or Magnetic Resonance Imaging (MRI), which can provide a three-dimensional image of your heart.
Structural Heart Disease Diagnosis
If screening tests or check-ups reveal abnormal results, your Wellstar physician will perform further evaluations regarding structural heart disease.
Procedures
- Physical Examination
- Chest X-rays
- Electrocardiogram (ECG)
- Echocardiogram
- Cardiac Stress Tests
- Cardiac Computerized Tomography (CT) Scan or Magnetic Resonance Imaging (MRI)
- Coronary Catheterization or angiogram
Structural Heart Disease Treatment
Currently, no medications can cure structural heart disease. However, lifestyle changes and medicines can often treat symptoms and delay complications for years. In time, surgery may be necessary to replace or repair the valve or atrial wall or other heart condition.
Medication
Your Wellstar physician may prescribe a combination of medications if you have been diagnosed with structural heart disease. Some of these medicines include:
- Antibiotics to prevent a recurrence of streptococcal infection in those who have had rheumatic fever.
- Blood thinners or Anticoagulant (Anti-clotting) drugs or anti-platelet therapy.
- Digoxin (Lanoxin®): This medication, also known as digitalis, may prevent episodes of congestive failure and control heart rhythm abnormalities.
- Diuretics: Sometimes called “water pills,” these medications work on your kidneys to help your body eliminate sodium and water, thus reducing blood volume.
- Beta-blockers: These medications reduce the heart’s workload and expand blood vessels, thus causing your heart to work slower with less force. These may include carvedilol (Coreg®), metoprolol (Lopressor®).
- Calcium channel blockers: These may lower the pressure in the aorta, which the left ventricle has to pump against.
Surgery
In some cases, your Wellstar physician may recommend surgery to correct defects in your heart or atrial wall or to repair or replace valves in your heart. Such a decision depends upon the severity of damage or defect, your age and health and whether other heart surgeries, such as a bypass, could be completed at the same time. Such surgeries include:
- Balloon dilatation or valvuloplasty, in which a small balloon is inserted into a blood vessel with a thin tube (catheter) and threaded to the narrowed valve and then inflated. When inflated, the balloon pushes back deposits around the valve. The balloon is then deflated and removed from the valve.
- PFO or ASD Closure
- Valve Repair, in which your Wellstar cardiothoracic surgeon may separate fused valve flaps, remove or reshape tissue so a valve can close tighter or add tissue to patch holes or tears to improve valve performance. This requires an open-heart surgical procedure.
- Valve Replacement, in which your Wellstar cardiothoracic surgeon removes the faulty valve and replaces it with a mechanical or biological tissue valve, i.e. bovine or porcine. This also requires an open-heart surgical procedure.
- Atrial Appendage Occlusion Device, a treatment strategy designed to prevent blood clot formations.
Ongoing Care for Structural Heart Disease
Wellstar provides top-flight cardiac care throughout its physicians’ offices, urgent care centers and emergency rooms. Emergency departments at Wellstar Cobb, Wellstar Douglas, and Wellstar Kennestone hospitals provide comprehensive cardiac services. Wellstar Cobb and Wellstar Kennestone hospital’s cardiac diagnostic and treatment services provide the next level of defense against heart disease. The technologically advanced Cardiac Center at Wellstar Kennestone Hospital and partnership with Emory Healthcare for adult open-heart surgery raises the bar on world-class cardiac care. Wellstar’s Cardiac Rehabilitation Services’ medically supervised programs focus on helping heart disease patients maintain a healthier heart through education and support groups.
At Home
Although many aspects of heart failure cannot be reversed, treatment can often improve symptoms and help you live longer. You and your Wellstar physician can work together to make your life more comfortable so pay close attention to your body and your post-treatment regimen and keep your doctor updated. As part of your post-treatment care and in addition to maintaining a healthy diet and exercise, you should:
- Keep track of all medications you take.
- Avoid certain over-the-counter medications, such as non-steroidal anti-inflammatory drugs (ibuprofen, naproxen and others), cold medications and diet pills.
- Keep track of your weight and blood pressure.
- Write down your questions and never be afraid to ask your Wellstar physicians for clarification.