What is aortic regurgitation

Goldman-Cecil Medicine. Philadelphia, PA: Elsevier; chap Aortic valve disease. PMID: pubmed. Otto CM. Valvular regurgitation. In: Otto CM, ed. Textbook of Clinical Echocardiography. Updated by: Michael A.

Editorial team. Aortic regurgitation. These include: Ankylosing spondylitis Aortic dissection Congenital present at birth valve problems, such as bicuspid valve Endocarditis infection of the heart valves High blood pressure Marfan syndrome Reiter syndrome also known as reactive arthritis Syphilis Systemic lupus erythematosus Trauma to the chest Aortic insufficiency is most common in men between the ages of 30 and They may include: Bounding pulse Chest pain similar to angina rare Fainting Fatigue Palpitations sensation of the heart beating Shortness of breath with activity or when lying down Waking up short of breath some time after falling asleep Swelling of the feet, legs, or abdomen Uneven, rapid, racing, pounding, or fluttering pulse Weakness that is more likely to occur with activity.

Exams and Tests. Signs may include: Heart murmur that can be heard through a stethoscope Very forceful beating of the heart Bobbing of the head in time with the heartbeat Hard pulses in the arms and legs Low diastolic blood pressure Signs of fluid in the lungs Aortic regurgitation may be seen on tests such as: Aortic angiography Echocardiogram -- ultrasound examination of the heart Left heart catheterization MRI or CT scan of the heart Transthoracic echocardiogram TTE or transesophageal echocardiogram TEE A chest x-ray may show swelling of the left lower heart chamber.

What's aortic valve regurgitation? What happens during aortic regurgitation? What are the symptoms of aortic valve regurgitation? Mild aortic regurgitation may produce few symptoms.

What causes aortic regurgitation? How is aortic regurgitation treated? Last Reviewed: May 8, As chronic aortic regurgitation worsens, regurgitant volume increases, as does stroke volume in order to maintain forward cardiac output. This results in increased systolic pressures, reduced diastolic pressures and widened pulse pressure. Increased stroke volume leads to a number of unusual peripheral physical examination findings, discussed below in Peripheral Signs.

The low diastolic aortic pressures can significantly affect coronary perfusion pressures, as coronary flow occurs during diastole. Afterload peripheral resistance is an important factor in the degree of aortic regurgitation. All other factors being equal, increased peripheral resistance will be associated with increased regurgitation.

Thus, afterload reduction has become the mainstay of pharmacotherapy in aortic regurgitation. Aortic regurgitation can result from abnormalities of the aortic valve leaflets or dilation of the aortic root, though an increase in afterload is not by itself a cause of aortic regurgitation. When the aortic leaflets are involved, a destructive process such as infective endocarditis or rheumatic valvular disease is frequently implicated. Any disease process that leads to aortic root dilation eg, Marfan syndrome or aortic dissection may cause enlargement of the aortic valve annulus; this results in failure of the leaflets to coapt close properly in diastole loss of coaptation and aortic regurgitation.

Frequently, repairs to the aortic root and valve are required in these conditions. The most common causes of acute aortic dissection include bacterial endocarditis, aortic dissection and blunt trauma-induced aortic valve damage Hamirani YS, et al.

As chronic aortic regurgitation develops slowly over time, the left ventricle slowly dilates and hypertrophies, as described previously. The disease remains asymptomatic for a long period of time. The later symptoms of chronic AR are mostly due to congestive heart failure. Left heart failure results in passive elevation of pulmonary pressures with dyspnea. Physical activity may even cause transient pulmonary edema.

Right heart failure symptoms include lower extremity-dependent edema and hepatic congestion. At night, when patients are recumbent, the excess extracellular fluid redistributes centrally, causing orthopnea the need to sit up to breathe or paroxysmal nocturnal dyspnea.

The large stroke volumes and forceful left ventricular contractions may cause head bobbing and awareness of the peripheral pulse. Angina may occur in the absence of atherosclerotic coronary disease, as the low diastolic pressures in severe aortic regurgitation compromise coronary filling, and the left ventricular hypertrophy increases oxygen demand.

Other symptoms related to low cardiac output include fatigue, weakness and, in extreme cases, cardiac cachexia. Unlike in chronic aortic regurgitation, almost all patients with significant acute aortic regurgitation are symptomatic. Signs of acute left heart failure — including severe dyspnea, dyspnea at rest, orthopnea and paroxysmal nocturnal dyspnea PND — arise. Patients typically present with symptoms of low cardiac output and systemic vasoconstriction, including pallor and coolness in the distal extremities, peripheral cyanosis and tachycardia with a reduced peripheral pulse.

Hypotension, flash pulmonary edema and shock can also occur. In chronic aortic regurgitation, visible cardiac and arterial pulsations are common due to the large stroke volume. The carotid pulse can commonly be seen. The point of maximal impulse PMI is displaced laterally and caudally due to the LV dilation and hypertrophy that occurs.

This murmur may be difficult to distinguish from the Graham-Steele murmur of pulmonic insufficiency. As aortic regurgitation worsens, the murmur becomes shorter, as less time is needed for left ventricular and aortic pressure equalization.

In addition, a systolic ejection murmur may be present at the right upper sternal border, simply due to the large stroke volume passing through the aortic valve with each left ventricular systolic contraction. An early diastolic rumble the Austin-Flint murmur may also be heard at the apex, due to the regurgitant jet striking the anterior leaflet of the mitral valve and causing it to vibrate.

In response to this need, the left ventricle of the heart may enlarge and thicken. At first, these adaptations help the left ventricle pump blood with more force. But eventually these changes weaken the left ventricle — and the heart overall in time.

People with aortic regurgitation may have no signs or symptoms for many years, and they may even be unaware that they have this condition until a doctor hears a heart murmur at a routine physical. Echocardiography an ultrasound of the heart is the gold standard in diagnosing aortic regurgitation. After the condition has been diagnosed by echocardiography, a catheterization may be performed to monitor pressures inside the heart as well as to check for additional coronary artery disease.

People without symptoms or with mild symptoms from aortic regurgitation should have regular check-ins with their cardiologist to monitor for changes in their condition. Once aortic valve regurgitation becomes severe, a procedure is often required to repair or replace the aortic valve.

Aortic valve repair or replacement for chronic severe aortic regurgitation is typically used for:. People with aortic regurgitation should have detailed counseling about physical activity.