Betula cordifolia young bark is shiny brown with pale brown lenticels. The leaves are alternate, ovate, 6–12 cm long, and double-toothed. As the specific epithet suggests, the leaf base is generally cordate (heart-shaped), however this can be misleading as it is occasionally flat or rounded. The leaves are dotted with many resin glands and the buds are ovoid and blunt. The twigs are yellow-brown to dark-brown and are dotted with resin glands and gray lenticels. They lack the hairs found on "Betula papyrifera". The flowers are catkins, with pollen catkins 2–4 cm long and seed catkins 1–2 cm long. The seed catkins
Beech bark disease to spread to the south and west. The first case of beech bark disease in the United States was reported in 1929 in Massachusetts. By 2004, the disease had spread as far west as Michigan and as far south as western North Carolina. For beech bark disease to occur, two components are required, an insect and a fungus. The beech scale insect, "Cryptococcus fagisuga", is invasive to North America and is host-specific, feeding exclusively on beech trees. It can be observed on the trunk and limbs of the tree as woolly, white tufts that will later develop into broad strips.