Aortic regurgitation

Alternative names
Aortic valve prolapse; Aortic insufficiency

Definition
Aortic insufficiency is a heart valve disease in which the aortic valve weakens or balloons, preventing the valve from closing tightly. This leads to backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (the left lower chamber of the heart).

Causes, incidence, and risk factors

Aortic insufficiency can result from any condition that weakens the aortic valve. In the past, rheumatic fever was the primary cause of aortic insufficiency. Now that antibiotics are used to treat rheumatic fever, other causes are more commonly seen.

These include congenital conditions (abnormalities of the valve which are present at birth), endocarditis (valve infection), High blood pressure, Marfan’s syndrome, aortic dissection (a tear in the lining of the aorta), Ankylosing spondylitis, Reiter’s syndrome, Syphilis (now rare), and other disorders.

Aortic insufficiency affects approximately 5 out of every 10,000 people. It is most common in men between the ages of 30 and 60.

Symptoms

     
  • marked, unpleasant sensation of heart beating (palpitations)  
  • pulse, bounding  
  • irregular, rapid, racing, pounding or fluttering pulse  
  • fainting  
  • weakness, particularly with activity  
  • Shortness of breath with activity or when lying down  
  • fatigue, excessive tiredness  
  • chest pain, angina type (rare)       o under the sternum, may radiate       o crushing, squeezing, pressure, tightness       o pain increases with exercise, relieves with rest

Note: Commonly, aortic insufficiency shows no symptoms for many years. Symptoms may then occur gradually or suddenly.

Signs and tests

Auscultation (listening to the chest with a stethoscope) detects a heart murmur. Palpation (examination by hand) may show hyperdynamic (very forceful) beating of the heart. Pulse pressure (the difference between systolic blood pressure - the pressure during contraction of the heart - and diastolic blood pressure - the pressure during relaxation of the heart) may be widened, and diastolic blood pressure may be low. There may be signs of pulmonary edema (fluid in the lungs).

Aortic insufficiency may be seen on:

     
  • echocardiogram- ultrasound axamination of the heart  
  • transesophageal echocardiogram (TEE)  
  • Doppler ultrasound  
  • aortic angiography  
  • left heart catheterization

An ECG test or Chest x-ray may show left ventriclar enlargement.

Lab tests cannot diagnose aortic insufficiency, but they may be used to rule out other disorders or causative factors.

Treatment

If there are no symptoms or if symptoms are mild, the disorder may only require observation. If symptoms are severe, hospitalization may be necessary. Medications such as diuretics (water pills) or digoxin may be used to stabilize the condition. These medications may also be used in people with mild symptoms to prevent the symptoms from worsening. Moderate activity restriction may be recommended.

Surgical repair or replacement of the aortic valve corrects aortic insufficiency. Surgical repair of the aorta may be required if insufficiency is caused by disorders of the aorta.

Expectations (prognosis)
Aortic insufficiency is curable with surgical repair. This can completely relieve symptoms unless severe heart failure is present or other complications develop.

Complications

     
  • left-sided heart failure  
  • pulmonary edema - water in the lungs  
  • endocarditis - infection of the valve

Calling your health care provider

Call your health care provider if symptoms indicate aortic insufficiency may be present.

Call your health care provider if you have aortic insufficiency and symptoms worsen or new symptoms develop, especially chest pain, difficulty breathing or edema (swelling).

Prevention

Treat strep infections promptly to prevent rheumatic fever, which can lead to aortic insufficiency. Aortic insufficiency caused by other conditions often cannot be prevented but some of the complications can be.

Notify your health care provider or dentist about any history of heart valve disease before treatment for any condition. Any dental work, including cleaning, and any invasive procedure can introduce bacteria into the bloodstream. This bacteria can infect a weakened valve, causing endocarditis.

Follow the provider’s treatment recommendations for conditions that may cause valve disease. Notify the provider if there is a family history of congenital heart diseases.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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