What Is Structural Heart Disease?
Not the plumbing. The building itself — valves, walls and chambers.
Most people picture heart disease as a blocked artery. Something furs up, something gets blocked, someone has a heart attack.
That is one kind of heart disease, and it is the most talked about. But a good number of the people we see have arteries that are perfectly fine. Their problem is with the structure of the heart itself.
Three different systems, three different problems
It helps to think of the heart as a building with three systems, because a problem in one tells you almost nothing about the others.
Plumbing
The plumbing is the coronary arteries, the vessels that supply the heart muscle with blood. When these narrow or block, that is coronary artery disease, and it causes angina and heart attacks. This is where angioplasty and stents are used.
Wiring
The wiring is the electrical system that sets the rhythm. When it misfires you get an irregular or racing heartbeat, such as atrial fibrillation.
Structure
The structure is the building itself: the four valves, the walls between the chambers, and the chambers. When one of these is narrowed, leaking, thickened or has a hole in it, that is structural heart disease.
You can have a structural problem with immaculate arteries. You can have severe coronary disease with perfect valves. Plenty of people have both, which is why they get looked at together.
Symptoms worth paying attention to
Structural problems develop slowly, and the body compensates quietly for a long time. By the time symptoms arrive, people have usually been adjusting their lives around them without noticing.
Breathlessness doing something that used to be easy, or when lying flat.
Tiredness that is new and not explained by anything else.
Chest tightness or pressure on exertion.
Dizziness, light-headedness or fainting, particularly during activity.
Swelling in the ankles, legs or abdomen.
A pounding or fluttering heartbeat.
The most common sentence we hear is "I just thought I was getting older". Sometimes that is true. If what you can comfortably do has changed over the past year, it is worth finding out which.
What counts as structural heart disease
Arrhythmias can be fast, slow, or irregular heart rhythms. Common types include atrial fibrillation, atrial flutter, supraventricular tachycardia (SVT), and bradycardia. Each affects the heart differently and may cause symptoms like palpitations, fatigue, or dizziness
Valve problems
The heart has four valves, and each one is a door that should open fully and close completely. Two things go wrong, and the words for them are worth knowing because you will hear them.
Stenosis means the valve has narrowed. The door does not open properly, so the heart has to force blood through a smaller gap and the muscle thickens from the effort.
Regurgitation means the valve leaks. The door does not close properly, so some blood goes backwards with every beat and the heart has to pump the same blood twice.
The most common in older adults, by a distance, is aortic stenosis, a narrowing of the valve between the heart and the body. It comes on over years as calcium builds on the valve, and it is routinely mistaken for aging. We have written about it in detail on our page on aortic valve replacement without open-heart surgery.
Mitral regurgitation, a leak in the valve between the left upper and lower chambers, is the next most common. Some of it is a problem with the valve itself. Some of it happens because the chamber around the valve has stretched, often after a heart attack or with heart failure, so the valve no longer closes even though it is structurally normal.
Tricuspid regurgitation, on the right side of the heart, was ignored for decades and is now taken much more seriously. It tends to show up as swelling in the legs and abdomen rather than breathlessness.
Holes between the chambers
Before birth, everyone has an opening between the two upper chambers of the heart, because a baby in the womb does not use its lungs. In most people it seals over in the first months of life. In around one in four it does not, leaving a small flap that never fully closed. That is a patent foramen ovale, or PFO.
For most people it never causes a problem and never needs anything done about it. It becomes relevant in one specific situation: a stroke in a younger adult where a thorough search finds no other cause. In that situation, closing the flap can reduce the chance of another one.
An atrial septal defect is a true hole rather than an unsealed flap, usually larger, and it can strain the right side of the heart over time.
Problems with the heart muscle and walls
Hypertrophic cardiomyopathy is an inherited condition where the heart muscle grows abnormally thick. In some people the thickened wall obstructs blood leaving the heart. It often runs in families, and it is one of the reasons a cardiologist asks whether anyone in your family died suddenly and young.
The left atrial appendage
This is a small pouch off the left upper chamber. In people with atrial fibrillation, blood can pool in it and form clots, which is where most AF-related strokes come from.
Blood-thinning medication is the standard protection. For people who cannot take it long term, usually because of serious bleeding, the pouch can be sealed off with a device delivered by catheter. Current national guidance treats that as a reasonable option for people at meaningful stroke risk who have a genuine reason not to be on anticoagulation, rather than as a first choice for everyone.
How it is found
Often by accident, and usually with a stethoscope. A valve that is narrowed or leaking makes a sound, and that murmur is frequently picked up at an appointment about something else entirely.
The test that confirms it is an echocardiogram, an ultrasound of the heart. It shows the valves moving in real time, measures how tight or leaky each one is, and shows how well the muscle is pumping. It takes about half an hour, involves no radiation and nothing is injected.
From there, depending on what is found, a CT scan measures the anatomy precisely before any procedure, and a coronary angiogram checks whether the plumbing needs attention at the same time.
How it is treated now
This is the part that has changed most, and it is why structural cardiology exists as a specialty at all.
Until relatively recently, fixing a valve meant open-heart surgery: the chest opened, the heart stopped, a bypass machine taking over. That is still the right answer for some people, and it is a very good operation.
But a growing number of these problems can now be treated through a catheter threaded up from a blood vessel in the leg, with the heart still beating and the chest never opened. The best known is transcatheter aortic valve replacement, where a new valve is delivered folded inside a tube and expanded inside the old one. Similar approaches exist for repairing a leaking mitral valve, closing a PFO or an atrial septal defect, and sealing the left atrial appendage.
Two honest caveats, because this is where patient pages tend to oversell.
Not everyone is a candidate. Anatomy decides a great deal of it, and imaging is what tells us. Some people are better served by surgery, and for a younger patient with a valve expected to last decades, surgery is often the better answer rather than the old-fashioned one.
Not every problem needs treating today. A good deal of structural cardiology is careful watching: a scan at the right interval, so that the moment to act is not missed and nothing is done earlier than it needs to be.
The heart team
Decisions in this area are meant to be made by a group rather than one person
A structural cardiologist, a cardiac surgeon and an imaging specialist look at the same scans and agree a recommendation together, with you in the conversation.
That is not a formality. For several of these conditions, national guidance specifically asks for it, because the choice between a catheter and an operation depends on factors no single specialty sees all of.
If you are being advised on a valve and a heart team has not been involved, it is entirely reasonable to ask for that.
FAQs
Common Questions
I have a heart murmur. Is that structural heart disease?
Not necessarily. Plenty of murmurs are harmless, and some are simply the sound of blood moving briskly. What settles it is an echocardiogram, and if you have been told you have a murmur and never had one, that is worth arranging.
Is this the same as heart failure?
No, though they are connected. Heart failure describes a heart that is not pumping or filling well enough. A structural problem is one of the things that can cause it, and treating the structural problem sometimes improves the heart failure considerably.
Can structural heart disease be prevented?
Some of it, partly. Blood pressure control helps, and rheumatic valve disease is prevented by treating strep throat properly. But a good deal of it is inherited or simply the result of time, and those parts are not anyone's fault. The useful thing is finding it early, which is why murmurs are worth chasing.
Do I need open-heart surgery?
Often not any more, and that is a genuine change rather than marketing. Whether a catheter approach suits you depends on which valve, your anatomy, your age and your other conditions. That is exactly what the heart team assessment is for.
I was told to wait and watch. Is that right?
Frequently, yes. Many structural problems are followed for years before anything is done, and acting too early has its own costs. What matters is that the watching is active, with scans at the right intervals and a clear plan for what would change the decision. If you have been told to wait but not told when you will next be checked, ask.
Can I get a second opinion?
Yes, and you should not feel awkward asking. Bring your echocardiogram and any CT images, ideally the actual images rather than only the report.
The short version
Coronary artery disease is a plumbing problem. Structural heart disease is a problem with the building itself: valves that have narrowed or started to leak, holes that never closed, walls that have thickened. It is usually found as a murmur and confirmed with an echocardiogram, and the symptoms — breathlessness, tiredness, chest tightness, dizziness, swelling — get mistaken for aging almost every time. A growing number of these problems can now be treated through a catheter rather than by opening the chest, though not everyone is a candidate and not every problem needs treating today. The decision is meant to be made by a heart team, with you in the room.
Book Your Next Appointment
Structural heart care in Fort Myers
Dr. Mazen Albaghdadi, MD is an interventional and structural cardiologist. Structural heart work is a distinct specialty within cardiology, and it is central to this practice rather than something referred elsewhere. The physician who assesses you is the one who performs your procedure, which is carried out in the hospital, with follow-up back at our office.
We see patients at 13411 Parker Commons Blvd, Fort Myers, on the north side of Daniels Parkway between I-75 and Six Mile Cypress, and care for people across Lee and Charlotte counties, including North Fort Myers, Cape Coral, Punta Gorda, Lehigh Acres, Estero, Bonita Springs and Naples.
If you have been told you have a murmur, a valve problem or a hole in the heart, or you simply want a second opinion on what you have been advised, we can tell you where you actually stand.
Call (239) 415-4900 or use the contact page to book. Physicians referring a patient can find what we need on the referral page. If you are not sure whether what you are noticing matters, read the seven warning signs it may be time to see a heart doctor.
This page is for general education. It is not a substitute for advice from your own doctor about your own case. If you have symptoms, contact your doctor. Call 911 for chest pressure lasting more than a few minutes, sudden severe breathlessness, or fainting.
Sources: 2020 ACC/AHA guideline for the management of patients with valvular heart disease; 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation; 2021 AHA/ASA guideline for the prevention of stroke in patients with stroke and transient ischemic attack.
