What conditions are included in structural heart disease?

What is Included in Structural Heart Disease

Structural heart disease encompasses any abnormality of cardiac structure or function, including disorders of the myocardium, pericardium, endocardium, heart valves, great vessels, and congenital cardiac anomalies. 1

Core Categories of Structural Heart Disease

Myocardial Disorders

• Cardiomyopathies of all types, including dilated cardiomyopathy, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy 2, 1
• Left ventricular hypertrophy and myocardial fibrosis 1
• Left ventricular dilatation or hypocontractility 1
• Infiltrative processes such as sarcoidosis and amyloidosis 2

Valvular Heart Disease

• All valvular abnormalities including aortic stenosis, aortic regurgitation, mitral regurgitation, mitral stenosis, and tricuspid regurgitation 2, 1, 3
• Bicuspid aortic valve disease and associated aortopathy 2
• Mitral valve prolapse 2

Congenital Heart Disease

• Congenital anomalies including atrial septal defects (ASD), patent foramen ovale (PFO), ventricular septal defects, and Ebstein anomaly 2, 3
• Coronary artery anomalies 2
• Complex structural abnormalities of the cardiovascular system present from birth 4

Pericardial Disease

• All disorders of the pericardium including pericardial effusion and tamponade 1, 3

Great Vessel Abnormalities

• Diseases of the great vessels including aortic dissection and aortic aneurysms 2, 1

Other Structural Abnormalities

• Cardiac tumors and masses 2, 3
• Immunologically mediated cardiac conditions 2
• Infectious processes affecting cardiac structure 2

Important Clinical Context

The presence of structural heart disease fundamentally changes risk stratification and management across multiple cardiac conditions. For example, in patients with bradycardia or conduction disorders, the prognosis is heavily influenced by whether underlying structural heart disease exists 2. Similarly, in patients with ventricular arrhythmias, identifying structural heart disease is critical for determining appropriate therapy 2.

What is NOT Included

The definition specifically excludes primary electrical disorders such as channelopathies (long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia) and familial arrhythmias when they occur in the absence of structural abnormalities 2. These are considered primary electrical diseases rather than structural heart disease.

Diagnostic Approach

Transthoracic echocardiography is the single most useful initial test for identifying and characterizing structural heart disease due to its ability to assess all cardiac structures comprehensively 1, 3. When echocardiography is insufficient, advanced imaging with cardiac MRI, CT, or transesophageal echocardiography should be considered 2, 1, 3.