(Aortic Insufficiency)
Aay-or-tick Ree-gur-jit-TAY-shun
Definition
Aortic regurgitation is a heart condition in which the valve between the left ventricle (lower left heart chamber) and the aorta (the major blood vessel leaving the heart) malfunctions. This valve defect allows the pumped out blood to leak back into the heart. As a result, the left ventricle must work harder to pump more blood than normal. This increased work gradually causes the left ventricle to enlarge. There are two main types of aortic regurgitation:
Acute Aortic Regurgitation – symptoms develop rapidly, and in severe cases, prompt surgery may be lifesaving
Chronic Aortic Regurgitation – symptoms develop over the course of many months or years
Aortic Valve Regurgitation
Causes
Possible structural causes of aortic regurgitation:
• The aortic valve itself is deformed and malfunctions
• A heart deformity or disturbance near the valve affects the valve’s functioning
Risk Factors
A risk factor is something that increases your chance for getting a disease or condition.
Acute Aortic Regurgitation
Risk factors for developing acute aortic regurgitation include:
• Infections of the heart such as:
o Rheumatic fever
o Infectious endocarditis
• Aortic dissection - separation of the inner layer of the aorta from the middle layer
• Trauma, such as an accident
Chronic Aortic Regurgitation
Risk factors for developing chronic aortic regurgitation include:
• Bicuspid aortic valve, a congenital (existing at birth) deformity in which the aortic valve has two cusps rather than three
• Other types of congenital heart disease
• Infections of the heart such as:
o Rheumatic fever
o Infectious endocarditis
• Diseases that cause widening of the aortic root (the part of the aorta attached to the ventricle) such as:
o Marfan syndrome
o High blood pressure
• Collagen vascular diseases, such as systemic lupus erythematosus
• Aortic aneurysm
• Sex: male
• Age: Over age 50
Symptoms
In acute aortic regurgitation, symptoms come on quickly since the heart has not had the time to compensate or enlarge. In chronic aortic regurgitation, symptoms develop more gradually and may not be noticed for years until the condition worsens.
In both cases, symptoms may include:
• Shortness of breath
• Fatigue, especially after physical activity
• Fluid retention in certain parts of the body, such as the ankles
• Heart arrhythmias (abnormal heart beats)
• Angina (chest pain from insufficient blood supply)
• Hypotension (low blood pressure)
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. In particular, the doctor will listen to your heart with a stethoscope to listen for a murmur (an abnormal heart sound). If you have a certain type of heart murmur, the doctor may suspect that you have aortic regurgitation and may recommend further tests, such as:
Electrocardiogram (EKG, ECG) – a test that records the heart's electrical activity using electrodes attached to the surface of the chest. In severe aortic regurgitation, the EKG may show abnormal electrical activity.
Chest X-ray – an x-ray to determine the approximate size and shape of the heart. In aortic regurgitation, the chest x-ray may show enlargement of the lower left ventricle, or in some cases, enlargement of the aorta.
Echocardiogram – a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart. It can detect leaking of the valves and abnormal thickening of the heart muscle. This test can also examine the functioning of the left ventricle.
Cardiac Catheterization – a tube inserted into the heart through an artery (usually in the groin) to detect problems with the heart's structure, function, and blood supply.
Radionucleotide Ventriculogram (nuclear scan) – measures how well the left ventricle is pumping as well as the amount of blood being pumped out of the ventricle with each heartbeat.
Treatment
In the case of severe acute aortic regurgitation, especially due to trauma, immediate surgery may be needed.
For chronic aortic regurgitation, the proper timing of medical therapy versus surgical treatment depends on several factors. These include:
• When you develop symptoms and how severe they are
• The degree of heart damage and level of heart function
• Your age
• The risks associated with the treatment
Treatment for aortic regurgitation may include:
Medications
If aortic regurgitation is not causing symptoms, and heart function remains normal, you may be treated with medications that lower blood pressure to reduce the pressure against which the heart pumps. Medication may also be given to treat chest pain, to treat irregular heartbeats, to prevent infection of damaged or artificial valves, and to prevent blood clots. If you have heart failure, you may be treated with medications that help your heart to pump more effectively.
Surgery
Surgery is usually performed for severe acute aortic regurgitation or when the timing is right for chronic aortic regurgitation. If you have chronic aortic regurgitation, your doctor will follow your symptoms and heart function closely in order to determine the best surgical timing for you. Surgery involves replacing the aortic valve.
Prevention
Prompt treatment of strep infections can prevent rheumatic fever, which is a risk factor for developing heart valve problems like aortic regurgitation. If a person has an abnormal valve, they are at higher risk of developing valve infections. People with abnormal valves should talk to their doctor to understand in what circumstances they may need to take antibiotics to decrease their risk of valve infection. For instance, they may need antibiotics before undergoing certain dental procedures or surgeries.
