Structural Heart Disease

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Structural heart disease affects the physical structure of your heart, most commonly the heart valves that control blood flow through the heart’s chambers. These conditions can develop over time due to aging, infection or other factors, or you may be born with them. (When you are born with a heart condition, it is known as congenital heart disease).

Your heart has four valves that act like one-way doors, ensuring blood flows in the right direction. When these valves don’t work as they should, they can:

  • Become too narrow (stenosis) — restricting blood flow and making your heart work harder
  • Fail to close completely (regurgitation) — allowing blood to leak backward instead of moving forward

Structural heart disease primarily affects adults over 60, though congenital forms can affect people of all ages. Left untreated, these conditions can lead to heart failure, irregular heart rhythms and other serious complications. The good news is that today’s treatments, including minimally invasive procedures, offer excellent outcomes for most patients.

Signs and Symptoms

Symptoms of structural heart disease can develop gradually and may include:

  • Shortness of breath, especially during activity or when lying flat
  • Chest pain or discomfort
  • Fatigue and weakness
  • Rapid or irregular heartbeat (palpitations)
  • Swollen ankles, feet or abdomen
  • Dizziness or lightheadedness
  • Difficulty exercising or reduced exercise tolerance
  • Heart murmur (detected by your doctor)

When to See a Doctor

Seek immediate medical attention if you experience severe chest pain, extreme shortness of breath, fainting or sudden onset of symptoms. Schedule an appointment with your doctor if you notice any persistent symptoms listed above, even if they seem mild. Early detection and treatment can prevent serious complications.

Causes

Structural heart disease can result from various causes:

  • Age-related Degeneration

The most common cause of structural heart issues is wear and tear over time. As you age, calcium deposits can accumulate on heart valves, making them stiff and narrow (calcific aortic stenosis).

  • Congenital Heart Conditions

Some people are born with abnormally formed heart valves or other structural abnormalities that may require treatment in childhood, adulthood or both.

  • Rheumatic Fever

A complication of untreated strep throat, rheumatic fever can damage heart valves, though this is now rare in developed countries.

  • Infections

Endocarditis, an infection of the heart’s inner lining, can damage heart valves.

  • Other Medical Conditions

Heart disease, high blood pressure, cardiomyopathy and connective tissue disorders can weaken or damage heart valves over time.

  • Previous Heart Surgery

Transplanted heart valves from previous surgeries can deteriorate over time, requiring intervention.

Diagnosis and Treatment

Norton Heart & Vascular Institute Structural Heart Program specialists use advanced diagnostic tools to assess your condition and determine the most appropriate treatment approach.

Structural Heart Testing

Echocardiogram (echo)

An ultrasound of your heart shows how your heart valves are functioning, measures blood flow and assesses heart chamber size and function. This is often the primary test for diagnosing structural heart disease.

Transesophageal Echocardiogram (TEE)

A specialized echo performed through the esophagus provides detailed images of heart valves and structures. It is used for complex cases or before certain procedures.

Cardiac Catheterization

A thin tube (catheter) is inserted through a blood vessel to measure pressures in your heart and assess valve function. Dye may be injected to visualize blood flow.

Electrocardiogram (ECG/EKG)

This test records your heart’s electrical activity to detect irregular rhythms that may be caused by structural heart disease.

Chest X-ray

X-ray imaging shows the size and shape of your heart and can reveal fluid buildup in your lungs.

CT scan or MRI

Advanced imaging techniques provide detailed, 3D views of your heart structure, helping plan procedures and assess complex cases.

Exercise Stress Test

Evaluating how your heart functions during physical activity can reveal symptoms or issues not apparent at rest.

Treatments

Treatment depends on the type and severity of your condition. Not all structural heart disease requires immediate treatment — some cases can be monitored over time. When treatment is needed, options include:

Minimally Invasive Procedures

Our specialists are leaders in advanced, catheter-based procedures that repair or replace heart valves without open heart surgery:

  • Transcatheter aortic valve replacement (TAVR)A new valve is inserted through a catheter, typically through a small incision in the groin, and positioned inside the diseased aortic valve. This procedure has revolutionized treatment for aortic stenosis, especially for patients at high risk for surgery.
  • MitraClip procedure — A small clip is placed on the mitral valve to improve closure and reduce regurgitation. The procedure is performed through a catheter inserted via a vein in the leg.
  • Transcatheter mitral valve replacement (TMVR)A newer procedure, TMVR replaces the mitral valve using catheter-based techniques, which is beneficial for certain patients with mitral regurgitation or stenosis.
  • Left atrial appendage closure — A Watchman device is used for patients with atrial fibrillation. A small device seals off a heart chamber where blood clots can form, reducing stroke risk.

Surgical procedures

While minimally invasive options continue to expand, some conditions still require traditional cardiac surgery:

  • Open valve repair

Surgical techniques to repair your own valve, preserving its natural structure when possible.

  • Open valve replacement

The diseased valve is removed and replaced with either a mechanical valve (made of durable materials) or a bioprosthetic valve (made from animal tissue).

Medications

While medications cannot cure structural heart disease, they can help manage symptoms and prevent complications:

  • Diuretics (water pills) — Reduce fluid buildup and swelling
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) — Lower blood pressure and reduce heart workload
  • Beta-blockers — Slow heart rate and reduce blood pressure
  • Blood thinners (anticoagulants) — Prevent blood clots, especially important for mechanical valve recipients
  • Antiarrhythmics — Control irregular heart rhythms
  • Antibiotics — Prevent endocarditis before dental or surgical procedures (for certain patients)

Lifestyle Changes

Your doctor may recommend lifestyle changes as part of your treatment plan:

  • Low-sodium diet — This helps reduce fluid retention and blood pressure.
  • Heart-healthy eating — Focus on fruits, vegetables, whole grains and lean proteins.
  • Specific diets — Eating diets such as the DASH diet can help control sodium.
  • Regular monitoring — Follow-up appointments and imaging tests are needed to track your condition.
  • Appropriate exercise — Your care team will advise you on safe activity levels for your specific condition.
  • Weight management — Maintaining a healthy weight reduces strain on your heart.
  • Smoking cessation — Quitting smoking improves heart health and outcomes,
  • Limiting alcohol — Excessive alcohol can worsen heart conditions.

Risk Factors

Certain factors increase your likelihood of developing structural heart disease:

  • Age — Risk increases significantly after age 60.
  • Family history — Congenital heart conditions and some valve conditions run in families.
  • Previous heart conditions — A prior heart attack, heart failure or cardiovascular disease diagnosis increases risk.
  • High blood pressure — This puts extra strain on heart valves over time.
  • High cholesterol — It can contribute to valve calcification.
  • Diabetes — Having diabetes increases risk of heart disease.
  • Chronic kidney disease — This condition is associated with valve calcification
  • Radiation therapy — Previous chest radiation for cancer treatment increases risk for structural heart disease.
  • Rheumatic fever history — Even if it’s from childhood, having rheumatic fever increases risk.
  • Autoimmune conditions — A history of lupus and other connective tissue disorders increases risk for structural heart disease.
  • Infections — A history of endocarditis brings increased risk.

Complications

Without proper treatment, structural heart disease can lead to serious complications. These include:

Heart Failure

When your heart can’t pump enough blood to meet your body’s needs, it leads to fatigue, shortness of breath and fluid retention.

Arrhythmias

Irregular heart rhythms, particularly atrial fibrillation, increase stroke risk.

Blood Clots and Stroke

Abnormal blood flow through damaged valves can lead to clot formation, potentially causing stroke if clots travel to the brain.

Endocarditis

Infection of the heart’s inner lining can further damage heart valves.

Sudden Cardiac Death

In severe untreated cases, particularly with aortic stenosis, there is increased risk of sudden cardiac events.

Pulmonary Hypertension

High blood pressure (hypertension) in the lungs results from backup of blood due to valve problems.

Prevention

While you can’t prevent all causes of structural heart disease, especially age-related changes or congenital conditions, you can reduce your risk.

  • Manage chronic conditions — Control high blood pressure, diabetes and high cholesterol.
  • Treat infections promptly — Address strep throat and other infections quickly to prevent rheumatic fever.
  • Practice good dental hygiene — Regular dental care prevents infections that could reach your heart.
  • Maintain a heart-healthy lifestyle — Eat nutritiously, exercise regularly and maintain a healthy weight.
  • Avoid smoking and excessive alcohol — Both can damage your cardiovascular system.
  • Know your family history — Alert your doctor if heart valve disease runs in your family.
  • Get regular checkups — Early detection allows for monitoring and timely intervention.

Managing Structural Heart Disease

If you’ve been diagnosed with structural heart disease, following these guidelines can help you stay healthy:

Attend All Follow-up Appointments

Regular monitoring with your cardiologist is crucial. You’ll need periodic echocardiograms and other tests to track any changes in your condition.

Take Medications as Prescribed

Never stop or change medications without consulting your doctor. Set reminders if needed to ensure you consistently take the medicine.

Know Your Symptoms

Be alert to changes in your symptoms or new symptoms developing. Report these to your care team promptly.

Carry Medical Information

Keep a note handy that includes your diagnosis, medications and emergency contacts. Wear a medical alert bracelet if recommended.

Stay Physically Active

Work with your care team to determine appropriate exercise levels. Many patients with structural heart disease can maintain active lifestyles with proper guidance.

Watch your Sodium Intake

Limit sodium to reduce fluid retention. Read food labels and avoid processed foods high in salt.

Monitor Your Weight

Weigh yourself daily at the same time. Sudden weight gain (2 to 3 pounds in a day or 5 pounds in a week) can indicate fluid retention — contact your doctor.

Pace Yourself

Break activities into smaller tasks. Rest when needed. Don’t push yourself to the point of severe shortness of breath or chest discomfort.

Stay Informed

Learn about your specific condition and treatment options. Don’t hesitate to ask your care team questions.

Support and Resources

Living with structural heart disease can be challenging, but you don’t have to navigate it alone. Norton Heart & Vascular Institute offers comprehensive support services to help you and your family throughout your journey.

Our patient support services include cardiac rehabilitation programs, nutritional counseling, support groups for heart patients and their families, and educational resources to help you understand and manage your condition.

Explore Patient Support Services

Next Steps

If you’re experiencing symptoms of structural heart disease or have been referred for evaluation, our team is here to help. The Norton Heart & Vascular Institute Structural Heart Program brings together leading specialists in the region to provide you with expertise, personalized treatment plans and compassionate care.

Early evaluation is important — many patients benefit from monitoring their condition before treatment becomes necessary, while others may need timely intervention to prevent complications.

About Norton Heart & Vascular Institute

Norton Heart & Vascular Institute offers advanced care at all of our adult-service hospitals to save hearts and lives.

Awards and Accreditations

  • Five of Norton Healthcare’s adult-service hospitals in Louisville have received Chest Pain Center accreditation from the American College of Cardiology (ACC).
  • Norton Audubon Hospital has been named a HeartCare Center National Distinction of Excellence year after year by the American College of Cardiology. This is the only hospital in Louisville to be recognized for this distinction.
  • Norton Audubon Hospital, Norton Brownsboro Hospital and Norton Hospital all are recognized as having ACC Chest Pain Center with Primary PCI accreditation.
  • Norton Audubon Hospital earned ventricular assist device accreditation from DNV and the Centers for Medicare & Medicaid Services.
  • Three of Norton Healthcare’s adult-service hospitals have received the American Heart Association Get With The Guidelines achievement awards for demonstrating commitment to following up-to-date, research-based guidelines for the treatment of heart disease and stroke, ultimately leading to more lives saved, shorter recovery times and fewer readmissions to the hospital.
    • Norton Audubon Hospital received Gold Plus
    • Norton Brownsboro Hospital received Gold Plus
    • Norton Hospital received Silver Plus

A Leader in the Region in Advanced Care

  • First in Louisville to implant a dual-chamber leadless pacemaker
  • First in Louisville to use PASCAL and MitraClip to replace and repair heart valves
  • First health care system in Louisville to offer CathWorks FFRangio System in a minimally invasive procedure to treat clogged arteries and advance heart disease
  • High success rate for extracorporeal membrane oxygenation interventions treating heart failure
  • Among the highest success rates in the nation for treatment of cardiogenic shock in heart failure
  • Over 100 transcarotid artery revascularization (TCAR) procedures performed for heart disease patients
  • Health system with the most facilities across the city of Louisville with the ability treat a life-threatening heart attack
  • More than 100 board-certified physicians and advanced practice providers with specialized heart and vascular training and experience at nearly 30 locations in Louisville and Southern Indiana

Comprehensive Heart Care for the Whole Person

Norton Heart & Vascular Institute offers patient resources to support you and your family, including free classes for people of all ages who want to improve cardiovascular health or are living with a heart condition.

  • Cardiac rehabilitation: Our cardiac rehabilitation providers are leaders in developing and applying innovative techniques that can help you recover and resume your life.
  • Connecting Hearts for Support group: The group provides education and support to individuals who have had a heart attack, are living with a heart condition or are at risk for cardiovascular disease.
  • Heart health screenings: Prevention is the best way to manage heart disease, and screenings are available to detect early signs of cardiac and vascular disease and identify risk factors.

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