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Aortic Regurgitation

(Aortic Insufficiency)

By

Guy P. Armstrong

, MD, Waitemata District Health Board and Waitemata Cardiology, Auckland

Last full review/revision Jul 2022| Content last modified Sep 2022
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Aortic regurgitation is leakage of blood back through the aortic valve each time the left ventricle relaxes.

The aortic valve is in the opening between the left ventricle and the ascending aorta (the large artery leading from the heart). The aortic valve opens as the left ventricle contracts to pump blood into the aorta. When the aortic valve does not close completely, blood leaks backward from the aorta into the left ventricle as the left ventricle relaxes to fill with blood from the left atrium. The backward leakage of blood, termed regurgitation, increases the volume and pressure of blood in the left ventricle. As a result, the amount of work the heart has to do increases. To compensate, the muscular walls of the ventricles thicken (hypertrophy), and the chambers of the ventricles enlarge (dilate). Eventually, despite this compensation, the heart may be unable to meet the body's need for blood, leading to heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) , with fluid accumulation in the lungs.

Causes of Aortic Regurgitation

Aortic valve regurgitation may develop suddenly (acute) or gradually (chronic).

The most common causes of acute aortic regurgitation are

The most common causes of chronic aortic regurgitation are

Rheumatic fever and syphilis Syphilis Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. Syphilis can occur in three stages of symptoms, separated by periods of apparent good health. It... read more Syphilis used to be the most common causes of aortic regurgitation in North America and Western Europe, where both disorders are now rare because of the widespread use of antibiotics. In regions where antibiotics are not widely used, aortic regurgitation due to rheumatic fever or syphilis is still common.

About 1% of babies have a bicuspid aortic valve, but it commonly does not cause problems until adulthood.

Symptoms of Aortic Regurgitation

Mild aortic regurgitation causes no symptom other than a characteristic heart murmur that can be heard with a stethoscope each time the left ventricle relaxes. People with severe regurgitation may develop symptoms when heart failure results.

Heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) causes shortness of breath during exertion. Lying flat, especially at night, makes breathing difficult. Sitting up allows backed-up fluid to drain out of the upper part of the lungs, restoring normal breathing. About 5% of people with aortic regurgitation have chest pain due to an inadequate blood supply to the heart muscle (angina Angina Angina is temporary chest pain or a sensation of pressure that occurs while the heart muscle is not receiving enough oxygen. A person with angina usually has discomfort or pressure beneath the... read more ), especially at night.

The pulse, sometimes called a collapsing pulse, is momentarily strong, then disappears quickly because the blood leaks backward through the aortic valve into the heart, causing blood pressure to decrease sharply.

Diagnosis of Aortic Regurgitation

  • Physical examination

  • Echocardiography

Treatment of Aortic Regurgitation

  • Valve repair or replacement

Drug treatment is not especially effective in slowing the progression of heart failure and does not eliminate the need for timely valve repair or replacement.

Echocardiography is done periodically to determine how rapidly the left ventricle is enlarging, which will help doctors determine when surgery should be done. The damaged valve should be surgically repaired or replaced with an artificial valve before the left ventricle becomes irreversibly damaged.

People who have had a valve replacement are given antibiotics before surgical, dental, or medical procedures (see table Examples of Procedures That Require Preventive Antibiotics Examples of Procedures That Require Preventive Antibiotics in the United States* Examples of Procedures That Require Preventive Antibiotics in the United States* ) to reduce the risk of infection of the heart valve.

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

NOTE: This is the Consumer Version. DOCTORS: CLICK HERE FOR THE PROFESSIONAL VERSION
CLICK HERE FOR THE PROFESSIONAL VERSION
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