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Structural heart disease refers to conditions that affect the structure and function of the heart, including its valves, chambers, and walls. These conditions could be congenital or may develop later in life due to various factors such as age, genetics, exposure to radiation, infections, or lifestyle. SHD can lead to various symptoms like shortness of breath, chest pain, dizziness, and loss of consciousness, as well as various sequela, including heart failure, arrhythmias and stroke, and therefore require prompt diagnosis and management.
Types of Structural Heart Diseases
There are several types of SHD, like:
Atrial Septal Defect (ASD) - a congenital defect (hole) in the wall that separates the two upper chambers (atria) of the heart. The hole allows oxygen-rich blood to flow from the left to the right atrium, increasing blood volume in the right atrium and lungs, causing shortness of breath, fatigue, and other symptoms.
Ventricular Septal Defect (VSD) - a congenital heart disease that occurs when a hole in the wall separates the two lower chambers of the heart (ventricles). This causes oxygen-rich blood from the left ventricle to flow into the right, increasing blood volume in the lungs. Symptoms include breathing difficulty, fatigue, and poor growth.
Aortic Stenosis - is a condition where the valve between the left ventricle and the aorta, the main artery carrying blood from the heart to the rest of the body is narrowed. This reduces blood flow to the body and can cause chest pain, shortness of breath and dizziness.
Mitral Valve Prolapse - occurs when the valve between the left atrium and the left ventricle does not close properly, leading to blood flowing back into the left atrium. This can cause shortness of breath, chest pain, and palpitations.
Pulmonary Stenosis - is caused due to narrowing of the valve between the right ventricle and the pulmonary artery, that transports blood from the heart to the lungs. This reduces blood flow to the lungs and can result in shortness of breath, fatigue, and chest pain.
Diagnosis of Structural Heart Disease
The diagnosis of SHD entails a thorough medical history, physical examination, and diagnostic tests. Some of the most common diagnostic tests include:
Electrocardiogram (ECG): assesses the electrical activity of the heart. It can be used to diagnose abnormal heart rhythms caused by SHD.
Echocardiogram: is a non-invasive test that uses ultrasound waves to create heart images. It can be used to assess the structure and function of the heart, including the size and shape of the chambers, the heart muscle's thickness, and the heart valve's function.
Cardiac CT: is a painless, safe, and noninvasive way to see detailed pictures of the heart. Cardiac MRI shows the parts of the heart and damages specific areas, if any.
Cardiac MRI: is a non-invasive imaging test that uses magnetic fields and radio waves to create detailed images of the heart. It can diagnose congenital disabilities, cardiomyopathy, and aortic aneurysm.
Cardiac Catheterization: is an invasive diagnostic test that involves insertion of a thin, flexible tube into a blood vessel in the arm, groin, or neck and guiding it to the heart. It measures the pressure in the heart, assesses the function of the heart valves, and diagnoses blockages in the coronary arteries.
Treatments for Structural Heart Disease
Treatment of SHD depends on various factors including the type and severity of the condition, as well as the individual's age, overall health, and medical history. Some of the most common treatments include:
Medications are often the first line of treatment prescribed for managing SHD. Depending on the type and severity of the condition, patients may be prescribed diuretics to reduce fluid buildup in the body, beta-blockers to slow the heart rate and lower BP, medication to improve heart function, reduce risk of complications, and prevent blood clots. Patients with valvular heart disease may also be given medicines to control blood pressure and heart rate.
Surgery
Surgery is often required to treat structural heart diseases that cannot be managed with medications alone. Some standard surgical procedures for structural heart diseases include:
Valve Repair or Replacement involves replacement of damaged or diseased heart valve and can be performed through open-heart surgery or minimally invasive procedures.
Coronary Artery Bypass Grafting (CABG): commonly known as open heart surgery, this involves bypassing a blocked or narrowed coronary artery with a healthy blood vessel from another body part.
Aortic Aneurysm Repair: Repair or replacement of an enlarged or weakened aorta through open-heart surgery or endovascular repair, which involves inserting a stent graft into the aorta to support the weakened area.
Cardiac Resynchronization Therapy (CRT): Usually performed for heart failure, this technique helps synchronize the electrical activity of the heart to improve its pumping efficiency.
Lifestyle changes are an essential part of managing structural heart diseases. Quitting smoking, adopting a healthy diet, and regular exercise are key aspects of heart health. Patients should work with their healthcare professionals to develop a personalized lifestyle plan that meets their needs and goals.
SHD are complex conditions requiring personalized treatment plans tailored to the individual's needs and health status. One should work closely with their healthcare provider to develop a comprehensive treatment plan that maximizes the benefits and minimizes the risks. Early diagnosis and treatment can improve treatment outcomes and boost the quality of life.
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