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Aortic Regurgitation

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(Aortic Insufficiency)

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) is not working properly. 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
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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:

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:
    • Rheumatic fever
    • Infectious endocarditis
  • Diseases that cause widening of the aortic root (the part of the aorta attached to the ventricle) such as:
  • 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. A physical exam will be done. In particular, the doctor will use 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:

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. These medications may 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 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 you have an abnormal valve, you are at higher risk of developing valve infections. You should talk with your doctor to understand when you may need to take antibiotics to decrease your risk of valve infection. For instance, you may need antibiotics before undergoing certain dental procedures or surgeries.

RESOURCES

American Heart Association http://www.heart.org

National Heart Lung and Blood Institute http://www.nhlbi.nih.gov

CANADIAN RESOURCES

Canadian Cardiovascular Society http://www.ccs.ca

Canadian Family Physician http://www.cfp.ca/

RESOURCES

Aortic regurgitation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamedUpdated October 10, 2012. Accessed November 7, 2012.

Cheitlin M. Surgery for chronic aortic regurgitation: when should it be considered? Am Fam Physician . 2001;64(10).

Tarasoutchi F, et al. Symptoms, left ventricular function, and timing of valve replacement surgery in patients with aortic regurgitation. Am Heart J . 1999;138:477-485.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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