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Overview
What is aortic regurgitation and insufficiency?
The aortic valve is one of the four valves in your heart. It is essentially a ‘doorway’ from the heart to the aorta, which is the body’s largest artery. When the heart pumps, the aortic valve opens so blood can go into the aorta then carries blood to the entire body. Aortic regurgitation (also called aortic insufficiency) is a heart valve condition in which the aortic valve does not close tightly. This allows blood to flow backward from the aorta into the left ventricle, which is the main pumping chamber of the heart.
When a large amount of blood comes back into the main pumping chamber, the heart must work harder to force out enough blood to meet the body's needs. Over time, usually many years, the main pump can enlarge. Early on, the heart pumps this extra blood effectively and can create a bounding pulse. Over time, the heart can further enlarge, weaken and become less able to pump blood forward to supply enough blood to the body, causing congestive heart failure.
What are symptoms of aortic regurgitation?
The condition often has no symptoms for many years. Symptoms may come slowly or suddenly. They may include:
- A heart murmur that can be heard through a stethoscope
- Very forceful beating of the heart
- Hard pulses in the arms and legs
- Bobbing of the head in time with the heartbeat
- Low diastolic blood pressure
- Weakness and fatigue that is more likely to occur with activity
- Fainting
- Shortness of breath with activity or when lying down
- Waking up short of breath after falling asleep
- Fluid in the lungs
- Swelling of the feet, legs, or abdomen
- Chest pain similar to angina (rare)
- Palpitations (sensation of the heart beating)
What causes aortic regurgitation?
Aortic insufficiency is most common in men between the ages of 30 and 60.
In the past, rheumatic fever was the main cause of aortic regurgitation. The use of antibiotics to treat important infections (mainly strep) has made rheumatic fever less common. Therefore, aortic regurgitation is now more commonly due to other causes. 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’s syndrome (also known as reactive arthritis)
- Syphilis
- Systemic lupus erythematosus
- Trauma to the chest
How doctors diagnose aortic regurgitation
Heart valve function can be detected through several physical tests including:
- A chest X-ray may show enlargement of the main heart chamber.
- Echocardiogram – ultrasound examination of the heart
- Aortic angiography
- MRI or CT scan of the heart
Lab tests cannot diagnose aortic insufficiency. However, they may help check for other causes of symptoms.
Aortic regurgitation treatment and medication
Aortic valve regurgitation is a lifelong condition. However, many people have heart valve defects or disease and may not have symptoms for many years. The condition may stay the same throughout your life and not cause any problems. Or the condition may slowly get worse until you start to notice symptoms. If not treated, significant heart valve disease can cause heart failure or other life-threatening conditions.
You may not need treatment if you have no symptoms or only mild symptoms. However, you will need to see a healthcare provider for regular exams and echocardiograms. Also, blood pressure control is very important if you have or are at high risk for developing aortic regurgitation.
Your healthcare provider may recommend healthy lifestyle changes or medicine first to treat symptoms, which may delay problems. Eventually, you may need to have your faulty heart valve repaired or replaced. After repair or replacement, you’ll still need certain medicines and regular checkups with your doctor.
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Lifestyle
Healthy lifestyle changes include:
- Choosing heart-healthy foods
- Aiming for a healthy weight
- Managing stress
- Getting regular physical activity
- Quitting smoking
Before starting any exercise program, ask your doctor about what level of physical activity is right for you.
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Medication
Your doctor may prescribe medicines to relieve the symptoms of your aortic valve disease or treat other heart problems that can affect your aortic valve. These may include:
- Medicines to control high blood pressure to ease pressure on the heart and reduce the amount of work the heart must do to pump blood
- Medicines to control the heart rate
- Blood thinners to treat or prevent blood clots
- Antibiotics to treat or prevent infections that cause heart inflammation, further valve damage or prevent rheumatic fever
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Procedures or surgery
Surgery to repair or replace the aortic valve is possible. The decision to have aortic valve replacement or repair depends on your symptoms and the condition and function of your heart. You may also need surgery to repair the aorta if it is enlarged. There is increasing interest in a minimally invasive procedure in which a replacement valve is implanted via a catheter. This is like a procedure traditionally done in people with aortic stenosis. This option may become more common in the future.
These surgeries and procedures can correct aortic insufficiency and relieve symptoms unless your valve disease has progressed far enough that you develop heart failure or other complications.
Aortic regurgitation treatment near you
Cardiology services at Ballad Health
Our extensive network of highly trained cardiologists, surgeons and advanced practice providers are here to support you and help you navigate a heart-related diagnosis.
Learn more about heart and vascular services at Ballad Health.
CVA Heart Institute Learning Center
We understand that receiving an aortic regurgitation diagnosis can be overwhelming. Our goal is to alleviate your fears and help you to understand your condition.
We have an informational video library, education tools and heart-related FAQs so that you have the resources you need.
Heart care patient stories
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Read our patient stories
Our patients inspire us every day, and we’re honored when they trust us with their care. They tell their stories best, so we’ve gathered a few here to share with you.
Many of these patients received life-saving care for heart conditions when they weren’t experiencing any symptoms. These experiences have changed they way they look at their individual care and helped them see the importance of regular preventive screenings.