Aortic Regurgitation

What Is Aortic Insufficiency?

The aorta is the large artery that leaves the heart from the left lower chamber (ventricle). The aortic valve is between the left ventricle and the aorta. Aortic insufficiency (also known as aortic regurgitation) is the leaking of blood from the aorta through the aortic valve into the left ventricle when the ventricle contracts.

Aortic insufficiency causes the left ventricle to get larger because of the extra blood in it.

What Causes Aortic Insufficiency?

The cause is a defective aortic valve or enlarged bottom part of the aorta. Infections such as rheumatic fever (usually from streptococcal infections) and endocarditis (bacterial infection in the heart) affect the valve. Congenital abnormalities such as bicuspid valve (two valve sections instead of three) are a common cause. Direct blunt injury (e.g., the chest hitting a steering wheel in an accident), connective tissue disorders such as Marfan’s disease, and hypertension can also lead to an enlarged aorta and subsequent aortic insufficiency.

What Are the Symptoms of Aortic Insufficiency?

Most people have no symptoms in early stages. Symptoms when present are tiredness, chest pain, difficulty breathing (especially when lying down), coughing, and shortness of breath.

How Is Aortic Insufficiency Diagnosed?

The health care provider makes a diagnosis from a physical examination. Blood flowing through the valve creates a heart murmur (extra or unusual sound during the heartbeat) that the health care provider hears with the stethoscope. The health care provider will recommend echocardiography (a test that uses ultrasound waves to give a picture of the heart) to confirm the diagnosis.

For severe insufficiency with effects on the heart’s function, the health care provider may suggest cardiac catheterization. In catheterization a small tube (catheter) is inserted into a leg artery and passed into the heart to get pictures of the heart and determine the severity of the aortic insufficiency.

How Is Aortic Insufficiency Treated?

For people without symptoms, the health care provider may recommend regular check-ups including echocardiograms. If testing shows worsening aortic insufficiency and/or an enlarged heart, the health care provider may suggest seeing a thoracic surgeon (a specialist who performs heart valve operations) to correct or replace the valve.

People with symptoms may also need medicines to prevent fluid and pressure from building up in the heart. The health care provider may also recommend referral to a thoracic surgeon in anticipation of future need for surgery.

DOs and DON’Ts in Managing Aortic Insufficiency:

• DO remember that you may not have symptoms but may need to be checked with echocardiograms to follow the valve disease.
• DO take antibiotics (if prescribed) before dental or surgical procedures if you had infectious endocarditis or prior heart surgery.
• DO ask your health care provider for referral to a cardiologist (a health care provider who specializes in heart diseases) if you are having symptoms.
• DO call your health care provider if you get shortness of breath, chest or upper back pain, palpitations or rapid heartbeat, or fainting.

• DON’T do strenuous exercise if you have severe insufficiency.
• DON’Tforget that periodic checkups to monitor for aortic insufficiency and its effect on the heart are important.

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

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