Cardiology is the medical specialty focused on the heart and the cardiovascular system. It involves the diagnosis, treatment, and prevention of conditions affecting the heart and blood vessels. These conditions include coronary artery disease, heart failure, arrhythmias (irregular heartbeats), and valve disorders. The field covers a broad spectrum, from congenital heart defects present at birth to acquired conditions like heart attacks.
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Structural heart disease is often called a “silent” condition because it can progress very slowly. The heart is an incredibly adaptable organ. When a valve starts to leak or narrow, the heart muscle compensates by working harder or changing its shape. Because of this, you might not feel sick immediately. In fact, many people attribute their slowing down to simply “getting older” or being out of shape, not realizing that a physical problem in their heart is the cause.
Recognizing the symptoms early is crucial for protecting the heart from permanent damage. Early identification of a structural problem increases treatment options. This section will outline the physical sensations and changes that might indicate a structural heart issue. We will also discuss the risk factors—both the ones you are born with and the ones you acquire—that might make you more likely to develop these conditions. Being aware of these signs empowers you to have better conversations with your doctor.
The most common symptom of structural heart disease is a reduction in physical ability. You might notice that you can no longer walk as far as you used to without stopping. Perhaps carrying groceries or walking up a flight of stairs leaves you winded. This issue is known as exercise intolerance. It happens because the heart cannot pump enough blood to meet the demands of the muscles during activity.
Shortness of breath, or dyspnea, is another hallmark sign. This might occur during exercise or, in more advanced cases, while you are lying flat in bed. You might wake up in the middle of the night gasping for air, needing to prop yourself up with pillows to breathe comfortably. This situation happens when pressure in the heart builds up and pushes fluid back into the lungs.
While chest pain is famously associated with heart attacks, it is also a symptom of structural heart problems, particularly aortic stenosis. This pain, often called angina, feels like a tightness, pressure, or squeezing sensation in the center of the chest. It typically happens when you are active and goes away when you rest.
Unlike a heart attack, which is sudden, this pain follows a pattern. It occurs because the heart muscle has to push against a stiff valve, requiring massive effort and oxygen. If the valve is too narrow, the heart muscle cannot get enough blood flow, leading to this cramping sensation. If you experience chest tightness during exertion, it is a strong signal that your heart is working too hard.
Structural heart defects often disrupt the electrical system of the heart. If a valve is leaking, the heart chambers may stretch and enlarge. This stretching can distort the electrical pathways, leading to irregular heartbeats, or arrhythmias. You might feel the condition as a “fluttering” sensation in your chest, a racing heart, or the feeling that your heart skipped a beat.
Atrial fibrillation (AFib) is very commonly linked to structural heart issues, especially mitral valve problems. In AFib, the upper chambers of the heart quiver instead of beating strongly. This can cause a rapid, chaotic heartbeat. If you have been diagnosed with AFib, your doctor will almost always check your heart structure to see if a valve problem is the underlying cause.
If structural heart disease is left untreated for a long time, it can lead to heart failure. This does not mean the heart stops beating; it means the heart fails to pump efficiently. When such an event happens, fluid begins to build up in the body. You might notice swelling in your legs, ankles, or feet. This condition is called edema.
This swelling is usually painless but can be severe enough that your shoes feel tight or you leave an indentation if you press on your skin. Fluid can also accumulate in the abdomen, causing bloating or a loss of appetite. Rapid weight gain—such as gaining three pounds in a day or five pounds in a week—is often a sign of fluid retention and should be checked by a doctor immediately.
Swelling in the lower body is a classic sign that the right side of the heart is struggling. If the tricuspid valve is leaking, pressure builds up in the veins, forcing fluid out into the tissues. This symptom is often worse at the end of the day or after standing for long periods.
When the left side of the heart is struggling—often due to aortic or mitral valve issues—fluid backs up into the lungs. This causes a persistent cough, sometimes producing white or pink mucus. It is the primary reason for the shortness of breath associated with structural heart disease.
Some factors that increase your chance of developing structural heart disease are beyond your control. Age is the most significant. As we get older, the tissues in our heart valves naturally lose their flexibility. Calcium deposits can form on the valve leaflets, causing them to stiffen. This is why aortic stenosis is most common in people over the age of 65.
Genetics also play a role. If you were born with a bicuspid aortic valve (where the valve has two leaflets instead of the normal three), you are much more likely to develop valve problems earlier in life. A family history of other congenital defects can also increase your risk. Understanding your family’s health history can help your doctor know what to look for.
While age is a major factor, your lifestyle and health history also contribute significantly. High blood pressure is a major enemy of heart valves. Chronic high pressure forces the heart to work harder and can cause the aortic root to widen, causing valves to leak. Managing blood pressure is one of the best ways to protect your heart structure.
A history of infections can also leave a mark. Rheumatic fever, which can develop from untreated strep throat, was a common cause of valve damage in the past and still affects many older adults. More recently, endocarditis—an infection of the inner lining of the heart valves—can cause sudden and severe structural damage. This infection can occur if bacteria enter the bloodstream, sometimes from poor dental hygiene or intravenous drug use.
Patients who have undergone radiation therapy to the chest for cancer treatment (such as for lymphoma or breast cancer) have a higher risk of developing valve disease later in life. The radiation can cause scarring and calcification of the heart valves years or even decades after the treatment has finished.
Conditions like kidney disease and autoimmune disorders (like lupus) can also accelerate valve damage. Kidney disease alters calcium metabolism in the body, which can speed up the hardening of heart valves. Being aware of these connections helps ensure that your heart is monitored if you have these other conditions.
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Structural heart disease symptoms can fluctuate based on your activity level, fluid intake, and overall health. You might have “good days” and “bad days,” but the underlying mechanical problem remains and usually worsens slowly over time.
Not necessarily. Many people have asymptomatic valve disease. It means the problem is there but mild. It requires regular monitoring (watchful waiting) to ensure it doesn’t get worse, but you don’t need to panic.
Yes, although women have much lower levels of testosterone than men, the hormone is still vital for their health, influencing libido, bone density, and energy levels. Women can experience deficiency, particularly after menopause or removal of the ovaries, though the diagnostic criteria and treatments are less standardized than for men.
Yes. Smoking damages blood vessels and increases the rate of atherosclerosis (hardening of arteries). This same process accelerates the calcification and stiffening of heart valves, particularly the aortic valve.
You should consult your doctor. Generally, light to moderate activity is good for the heart, but if you have severe stenosis, heavy exertion can be dangerous. Your doctor will give you safe limits based on your specific condition.
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