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Aortic Valve Regurgitation - Symptoms, Diagnosis, and Treatment

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Aortic regurgitation is a disease in which the blood flows backward from the aorta into the left ventricle during the diastole. Read the article to know more.

Medically reviewed by

Dr. Muhammad Zohaib Siddiq

Published At November 24, 2022
Reviewed AtJanuary 19, 2023

Introduction

The heart comprises four valves that regulate blood flow, and the aortic valve is one of them. It has three sections or leaflets (the left, right and posterior), the aortic valve separates the ascending aorta from the left ventricle (lower left chamber), which is the heart's main pumping chamber. The aortic valve typically opens three to five square centimeters during the heart's contraction (systole). Then, as the heart relaxes (diastole), this valve closes and prevents leakage of blood from the ascending aorta backward to the heart. Throughout one's lifespan, the aortic valve opens and closes an average of several billion times.

What Is Aortic Valve Regurgitation?

The aortic valve ensures a one-way flow of oxygen-rich blood from the left ventricle to the aorta of the body. It opens when the left ventricle contracts, pumps blood and closes when the left ventricle refills to prevent blood from flowing back to the left ventricle. Aortic regurgitation, also known as aortic insufficiency, is a valvular heart disease that occurs when the valve does not close tightly, causing backward flow to the ventricle. In order to compensate for the low blood output, the left ventricle grows larger to generate higher pressures and pump harder. This enlargement may help to relieve symptoms at first, but eventually, it leads to the weakening and malfunctioning of the ventricle.

What Are the Other Names of Aortic Regurgitation?

Aortic regurgitation (AV) is also known as aortic valvular regurgitation and aortic insufficiency.

What Signs and Symptoms Are Associated With Aortic Valve Regurgitation (AV)?

Signs and symptoms usually develop slowly over decades. The following signs and symptoms are associated with aortic valvular regurgitation-

  • Dyspnea (shortness of breath, especially with increased physical activity.).

  • Fatigue and tiredness.

  • Weakness.

  • Heart murmur.

  • Arrhythmia (irregular heartbeat).

  • Lightheadedness.

  • Exertional angina (chest pain or tightness is observed with increased physical activity).

  • Palpitations.

  • Edema (swelling) in the lower extremities, especially in ankles and feet.

  • Hypotension (decreased blood pressure).

On physical examination, aortic valve regurgitation (AR) produces a diastolic murmur heard along the left sternal border. It is a classical sign of aortic valve regurgitation. It peaks at the beginning of diastole (relaxation of the heart) when the flow is largest, then rapidly decreases as the ventricles are filled.

What Are the Causes of Aortic Valve Regurgitation (AR)?

There are several causes of aortic valvular regurgitation, such as:

  • Myocardial Infarction (MI)- It is commonly known as heart attack. It is a severe medical condition that usually occurs when an artery or blood vessel supplying the heart has plaque (fatty and waxy substance) built up within its walls and that plaque suddenly breaks. It causes injury to the walls of the blood vessels and leads to bleeding within the blood vessels. In order to stop this bleeding, platelets act together and form a blood clot. It prevents the blood from flowing through and reaching the heart muscles. This reduced or diminished blood flow further starves the heart tissue of nutrients and oxygen, causing cardiac ischemia. Eventually, the heart tissue dies, leading to a heart attack.

  • Endocarditis- A disease characterized by the inflammation of the inner lining of the heart's chamber and valves which can be life-threatening.

  • Rheumatic Fever- An inflammatory disease that affects the heart that arises from infection with group A Streptococcus bacteria, which are commonly found on the surface of the skin and throat. This group of bacteria is responsible for various diseases, ranging from mild illnesses such as strep throat to severe conditions such as cellulitis and necrotizing fasciitis.

  • Aortic Dissection- A medical condition in which the tunica intima (innermost layer) of the aorta (blood vessel) is ripped off. A tear forms within the innermost layer of the aorta, and when the high-pressured blood flows through the aorta, it begins to tunnel between the muscular layers of the aorta.

  • Valvular Heart Disease Like Aortic Sclerosis and Aortic Stenosis- Although thickening the aortic valve characterizes both conditions, they differ. Aortic valve sclerosis is a condition wherein the aortic valve thickens but does not obstruct blood flow, unlike aortic valve stenosis, wherein the blood flow is completely blocked.

  • Aortic Damage- This can occur due to a traumatic injury to the chest.

How Is Aortic Valve Regurgitation Diagnosed?

Along with physical examination, aortic valve regurgitation or aortic insufficiency can be diagnosed by the following tests:

  • Echocardiogram: The heart and surrounding blood vessels are examined using an echocardiogram or echo scan. It is a cardiac ultrasound test in which a tiny probe emits high-frequency sound waves that make echoes once they bounce off different body parts. While the scan is being done, the probe picks up these echoes and transforms them into a moving image on a monitor.

  • Magnetic Resonance Imaging (MRI) or Cardiac Magnetic Resonance Imaging: It is a comprehensive imaging test that gives great details of the heart and its associated structures. Images of the heart are created using a giant magnet and a computer. It can help the clinician identify the type and severity of the heart disease in a patient.

  • Chest Radiograph (X-Ray): A diagnostic test that records images of the lungs, heart, and airways using special beams of radiation called the X-ray beam. It is the most widely used diagnostic procedure for acquiring pictures of the heart, lungs, airways, and bones in the spine and chest. It is a painless, non-invasive procedure that uses special radiation beams (X-ray beams) to create black-and-white images of the chest cavity.

  • Cardiac Catheterization: Cardiac catheterization, or a traditional angiogram, has been a gold standard test for assessing the health of a human heart. A conventional coronary angiogram is an invasive procedure that involves passing a catheter (a thin, flexible tube) into the blood vessel (arteries). At times, doctors may advise a contrast angiography. It involves using a special dye (also known as contrast) injected that helps in amplifying the images.

  • Electrocardiogram (ECG or EKG): With the help of numerous electrodes (tiny sensors that are adhered to different parts of the body), it records the electrical signals from the heart, which helps in identifying the extra heartbeats and helps locate the origin of the extra heartbeat too. It is a rapid and painless test.

  • Stress Test: A test that analyzes the response of a heart during an intense level of activity. It is done with the help of an EKG (electrocardiograph) machine and a treadmill or stationary bike.

What Is the Treatment for Aortic Valve Regurgitation (AV)?

Aortic valvular regurgitation (AR) or aortic insufficiency is managed on the presence of signs and symptoms and their severity. The patient is regularly monitored (routine echocardiograms) for mild symptoms. The physician may also advise the following medications:

  • Calcium channel blockers and beta-blockers regulate high blood pressure.

  • Antiarrhythmics for regulating the heart's rhythm.

  • Diuretics (also known as water pills) for minimizing peripheral swelling.

Surgical intervention is done if:

  • There are severe signs and symptoms.

  • Aortic regurgitation leads to left ventricular (LV) dysfunction.

Surgical methods for valve repair include either the traditional open-heart aortic valve replacement or transcatheter aortic valve replacement (TAVR). Transcatheter aortic valve replacement is a relatively new and minimally invasive procedure that does not emphasize opening the chest cavity, as in traditional open-heart surgery. Instead, the surgeon uses a catheter (a thin tube that is highly flexible) to replace the damaged aortic valve with a biological tissue valve. The biological valve is a valve that is made from a cow's or pig's tissue.

What Are the Risk Factors Associated With Aortic Valve Regurgitation?

The following factors make an individual vulnerable to developing aortic valve regurgitation.

  • Increased Age: Aortic valve regurgitation is more common in elderly individuals.

  • Hypertension: It is defined as increased blood pressure, which makes an individual susceptible to heart disease. It is a severe condition that can lead to the wear and tear of blood vessels, consequently causing cardiac problems like myocardial infarctions (MI or heart attacks), aneurysms (weakening or ballooning of the blood vessels), or strokes (brain damage occurring due to disruption in the blood supply of the brain). Hypertension could either be primary or secondary.

  • Congenital Heart Diseases: Individuals born with abnormal heart structures have an increased risk of valvular dysfunction. For example, Individuals with an aortic valve having two leaflets (bicuspid valve) instead of three (tricuspid valve) are more susceptible to aortic valve insufficiency or aortic valve regurgitation.

  • Valvular Heart Diseases: For example, aortic sclerosis and aortic stenosis.

What Are the Complications Associated With Aortic Valvular Regurgitation?

If not treated aptly, aortic valve regurgitation can lead to:

  • Heart failure.

  • Arrhythmias (irregular heartbeats).

  • Death.

What Measures Can an Individual Take To Prevent Aortic Valve Regurgitation?

No guaranteed health plan could prevent aortic valve regurgitation, but the following measures can help to some extent-

  • Keeping blood pressure within acceptable ranges.

  • Making healthy dietary choices.

  • Managing body weight.

  • Avoid smoking.

Conclusion

Aortic regurgitation, also known as aortic insufficiency, is a valvular heart disease characterized by leakage in the aortic valve, which separates the aorta from the left ventricle. Symptoms usually develop slowly over decades but can be acute as well. As long as proper care is given as needed, aortic valve regurgitation has a positive outlook.

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Dr. Muhammad Zohaib Siddiq
Dr. Muhammad Zohaib Siddiq

Cardiology

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