What it is
Heart failure does not mean the heart has stopped. It means the heart is not pumping or filling as well as the body needs. Heart failure symptoms can include shortness of breath, tiredness, swelling in the legs or belly, and trouble lying flat. These signs can also have other causes, so only a licensed clinician can say what is going on.
Valve disease involves the heart's four valves, which act like one-way doors for blood. A valve can become stiff and narrow, or it can leak because it does not close fully. Either problem can make the heart work harder. Some people have valve differences from birth, and others develop them over time.
A heart murmur is an extra whooshing sound a clinician may hear through a stethoscope. Heart murmur causes range from harmless, normal blood flow to a valve problem or another structural difference. A murmur is a finding, not a diagnosis. Heart failure and valve disease can be linked, and some forms of both can run in families, which is one reason genetic heart testing is sometimes discussed.
How it’s traditionally been approached
Evaluation has traditionally begun with a conversation about symptoms and family history, a physical exam, and listening to the heart. A cardiologist may then use tools such as an electrocardiogram, an echocardiogram (heart ultrasound), bloodwork or other imaging to see how the heart and valves are working.
Congestive heart failure treatment has traditionally combined lifestyle guidance, medicines and regular follow-up, with devices or procedures used for some people. For valve disease, clinicians may watch a valve over time, or they may discuss repair or replacement. Which path fits depends on the person and is decided by a licensed clinician after an evaluation.
Heart valve replacement options have traditionally included open-heart surgery with a mechanical or tissue valve. Less invasive approaches now exist for some people. TAVR (transcatheter aortic valve replacement) places a new valve through a thin tube, and mitral valve repair may be done surgically or with catheter-based methods. Each option is regulated, and its suitability depends on the individual. Ask a provider about the current regulatory status of any device or procedure you are curious about.
How the right cardiologist may help
The right cardiologist may help by looking at the whole picture: your symptoms, your history, your family's heart history, and test results. Some cardiologists focus on heart failure, valve disease or structural heart care, and a few work with genetic counselors when an inherited condition is a possibility. Finding someone who fits your situation is a possibility, not a promise of any outcome.
A first visit often includes questions about when symptoms started and what makes them better or worse. It also covers medicines, family history and daily life. You may have an exam and some tests. Bring a written list of symptoms, medicines and supplements, and any records you have. A family member can help you remember what was said.
Questions you might ask include: What do you think is causing my symptoms? What tests do you recommend, and why? Is my valve being watched, repaired or replaced, and what are the options? How would TAVR or mitral valve repair apply to me, if at all? Does my family history suggest genetic heart testing, and would genetic counseling first make sense? How does my insurance cover these steps? Please confirm coverage with your insurer and provider.
The whole-person view
The body, mind and stress affect one another. Living with shortness of breath, fatigue or an uncertain diagnosis can bring worry, low mood or sleep trouble. Stress and poor sleep can in turn make symptoms feel heavier. Looking after the whole person is a reasonable part of an overall conversation with your care team.
Some people find body-based support helpful for feeling more settled, and Somatic Experiences lists practitioners who offer it. Others value talking with someone, and Therapists.plus can help you find talk therapy. These can sit alongside medical care and never replace it. Be kind to yourself and don't compare your path with anyone else's.
Somatic Experiences: nervous system regulation →Somatic Experiences: embodiment and movement →Therapists.plus: anxiety panic and ocd →Therapists.plus: mind body connection →
Keep in mind
- This page is educational only and is not medical advice. Licensed professionals should guide all decisions about testing, medicines, devices and procedures.
- Genetic tests show risk or carrier status and do not diagnose heart disease on their own. A negative result does not rule out risk, and a variant of uncertain significance is not a diagnosis. Results need interpretation by a qualified cardiologist, electrophysiologist or genetic counselor, and counseling before and after testing is recommended.
- GINA protects against genetic discrimination in US health insurance and employment, but it does not cover life, disability or long-term-care insurance, so ask about those before testing. Coverage for testing and procedures varies by insurer, state and diagnosis.
- For emergencies such as chest pain, severe trouble breathing or fainting, call 911. In an emotional crisis, call or text 988.
Guides in this topic
Cardiologist types
Frequently asked questions
What are the common heart failure symptoms?
Common heart failure symptoms can include shortness of breath, feeling very tired, swelling in the legs, ankles or belly, and trouble breathing when lying flat. These signs can have many causes, so they are not a diagnosis. If you notice them, talk with a licensed clinician, and call 911 for severe symptoms.
How is congestive heart failure treatment approached?
Congestive heart failure treatment is individualized and decided by a licensed clinician. It has traditionally combined lifestyle guidance, medicines, regular monitoring and, for some people, devices or procedures. A cardiologist can explain which approaches may apply to you after an evaluation.
What are heart valve replacement options?
Heart valve replacement options have traditionally included surgical replacement with a mechanical or tissue valve, and less invasive catheter-based approaches for some valves. Which option is appropriate depends on the valve involved and the person's overall health. A cardiologist and care team decide this after evaluation, so ask your provider about the options and each one's regulatory status.
What is the TAVR procedure?
The TAVR procedure, or transcatheter aortic valve replacement, replaces a narrowed aortic valve using a thin tube guided through a blood vessel, rather than traditional open-heart surgery. It is not right for everyone, and a heart team decides whether it fits a given person. Ask your cardiologist about benefits, risks, regulatory status and insurance coverage.
What is mitral valve repair?
Mitral valve repair is a way of fixing a mitral valve that leaks or does not open well, instead of replacing it. It may be done through surgery, and some catheter-based methods exist for certain people. A cardiologist can explain whether repair, replacement or watchful monitoring may be discussed in your case.
What are the heart murmur causes?
Heart murmur causes include normal, harmless blood flow as well as valve problems and other structural differences in the heart. A murmur is a sound a clinician hears, not a diagnosis. A cardiologist may use an exam and imaging such as an echocardiogram to understand what is behind it.
Educational resource. CardioGenes shares general information and connects people with independent cardiologists. It is not medical advice, diagnosis or treatment. Talk with a licensed professional about your health.