Aortic Regurgitation

What is aortic regurgitation? Aortic regurgitation refers to a leaky aortic valve. With this condition, the leaflets (flaps) of your aortic valve don’t close as tightly as they should. As a result, some blood that should move out of your heart leaks backward each time your heart beats. Aortic regurgitation is a form of heart valve disease that ranges from mild to severe. It requires careful monitoring by a healthcare provider. Other names for aortic regurgitation include: Aortic insufficiency. Aortic valve regurgitation. Leaky aortic valve.

What happens in aortic insufficiency? Your aortic valve is the “door” that controls blood flow between your heart and your aorta (the largest artery in your body). With each heartbeat, your heart pumps oxygen-rich blood into your aorta. From there, your blood then travels through many branches to reach your organs and tissues. But to successfully nourish your body, your blood first needs to leave your heart. That’s where your aortic valve comes into play. Your aortic valve opens to allow blood to travel from the left ventricle of your heart (its main pumping chamber) into your aorta. This happens each time your left ventricle contracts (systole). When your left ventricle relaxes (diastole), your aortic valve closes. Normally, your aortic valve closes tightly enough to keep blood flowing in the correct direction. However, if you have aortic regurgitation, your valve doesn’t close all the way. This means that each time your left ventricle relaxes, some blood leaks backward into this chamber. Mild regurgitation may cause no symptoms or problems. But over time, the condition can get worse and lead to volume overload of your left ventricle. That’s because, normally, your left ventricle should only receive blood from your top left heart chamber (left atrium). Your left ventricle is capable of managing this amount of blood. However, a leaky aortic valve causes extra blood to flow into your left ventricle. This makes your left ventricle do more work to manage this extra blood volume. When the volume overload happens quickly and suddenly, you have acute aortic regurgitation. If the overload happens gradually over time, you have chronic aortic regurgitation. The chronic form is more common in the U.S.

How does a leaky aortic valve affect my body? Aortic regurgitation forces your heart’s left ventricle to work harder to pump enough blood into your aorta. Over time, this can cause the muscular walls of your left ventricle to thicken (left ventricular hypertrophy). Left ventricular hypertrophy makes your heart less efficient. It can ultimately lead to: Heart failure. Arrhythmia. Heart attack. Stroke.

Who does aortic regurgitation affect?

Aortic regurgitation can affect a wide range of people, including those who have:

- Congenital heart disease, especially a bicuspid aortic valve (BAV). A congenital condition is a condition you’re born with. People with BAV often develop a leaky valve between the ages of 20 and 40.

- A calcified aortic valve. People with a calcified aortic valve are usually over age 60 and have mixed valve disease (more than one type of valve problem). In this case, they have aortic stenosis along with some level of regurgitation.

- Previous aortic valve replacement. A bioprosthetic valve may break down over time and not work as it should.

- Rheumatic heart disease. Rheumatic fever causes rheumatic heart disease, which is a leading cause of aortic regurgitation in low- and middle-income nations.

What are the symptoms of aortic regurgitation?

Symptoms of acute aortic regurgitation include:

- Chest pain.

- Cough.

- Heart palpitations.

- Shortness of breath (dyspnea) with physical activity.

Chronic, mild aortic regurgitation may not cause any symptoms for a long time. However, as your condition gets worse, you may gradually develop symptoms that include:

- Chest pain.

- Fainting (syncope).

- Heart palpitations.

- Shortness of breath with physical activity, when lying down or when trying to sleep.

- Swelling (edema) in your ankles and feet.

What causes aortic regurgitation?

Causes of aortic regurgitation include:

- Valve degeneration due to aging (most common cause in the U.S. and Western Europe).

- Rheumatic heart disease (most common cause in many developing nations).

- High blood pressure.

- Endocarditis.

- Trauma to your chest (such as a car accident).

- Thoracic aortic aneurysm.

- Aortic dissection.

What are the risk factors?

Certain changes to your aortic valve anatomy and other medical conditions make you more likely to develop a leaky aortic valve. You’re at risk for aortic regurgitation if you have:

- Bicuspid aortic valve or another congenital valve disorder.

- Calcification of your aortic valve flaps.

- Aortopathy (aortic disease) that affects your ascending aorta.

- History of rheumatic fever or a diagnosis of rheumatic heart disease.

How is aortic regurgitation diagnosed?

Healthcare providers diagnose aortic regurgitation through a physical exam and testing.

During a physical exam, your provider:

Talks to you about your medical history.

Checks your vital signs, including your blood pressure. Measuring your blood pressure allows your provider to calculate your pulse pressure. This is the difference between the top and bottom numbers in your blood pressure, measured in millimeters of mercury (mmHg). A wide pulse pressure (greater than 40 mmHg) could indicate a leaky aortic valve. A narrow pulse pressure (one-fourth or less of your top number) may indicate the presence of heart failure.

Uses a stethoscope to listen to your heart (auscultation) and check for abnormal sounds, such as a murmur. If you have aortic regurgitation, your provider may hear a sound called an Austin Flint murmur. The physician, Austin Flint, discovered this particular murmur in 1862. The quick, backward flow of blood into your left ventricle causes this sound.

What tests diagnose this condition?

An echocardiogram (echo) is the gold standard for diagnosing aortic regurgitation. This test uses high-frequency sound waves (ultrasound) to take pictures of your heart. Your provider can use different techniques, like Doppler ultrasound, to check your valve function. Doppler ultrasound shows the speed and direction of blood flow through your heart.

Other tests you may need to diagnose aortic regurgitation or plan treatment include:

- Chest X-ray.

- Electrocardiogram (ECG/EKG).

- Heart MRI.

- Coronary angiogram.