Aortic insufficiency

Causes

Aortic insufficiency can result from any condition that keeps the aortic valve from closing all the way. A small amount of blood comes back each time the heart beats.

The condition causes widening (dilation) of the left lower chamber of the heart. Larger amounts of blood leave the heart with each squeeze or contraction. This leads to a strong and forceful pulse (bounding pulse). Over time, the heart becomes less able to pump blood to the body.

In the past, rheumatic fever was the main cause of aortic insufficiency. Now that antibiotics are used to treat rheumatic fever, other causes are more commonly seen.

Causes of aortic insufficiency may include:

• Ankylosing spondylitis
• Aortic dissection
• Congenital (present at birth) valve problems, such as bicuspid valve
• Endocarditis
• High blood pressure
• Marfan syndrome
• Reiter syndrome
• Syphilis
• Systemic lupus erythematosus

Aortic insufficiency is most common in men between the ages of 30 and 60.

Symptoms

Aortic insufficiency often has no symptoms for many years. Symptoms may occur slowly or suddenly.

• Bounding pulse
• Chest pain, angina type (rare)
  • Under the chest bone; pain may move to other areas of the body, most often the left side of the chest
  • Crushing, squeezing, pressure, tightness
  • Pain increases with exercise and goes away with rest
• Fainting
• Fatigue    
• Palpitations (sensation of the heart beating)
• Shortness of breath with activity or when lying down
• Swelling of the feet, legs, or abdomen
• Uneven, rapid, racing, pounding, or fluttering pulse
• Weakness, more often with activity

Exams and Tests

Signs may include:

• A heart murmur when the health care provider listens to the chest with a stethoscope
• A very forceful beating of the heart
• The head may bob in time with the heartbeat
• Hard pulses in the arms and legs
• Low diastolic blood pressure
• Signs of fluid in the lungs

Aortic insufficiency may be seen on:

• Aortic angiography
• Echocardiogram - ultrasound examination of the heart
• Left heart catheterization
• MRI of the heart
• Transesophageal echocardiogram (TEE)

A chest x-ray may show swelling of the left lower heart chamber.

Lab tests cannot diagnose aortic insufficiency, but they may be used to rule out other disorders or causes.

Treatment

If there are no symptoms or if symptoms are mild, you may only need to get an echocardiogram from time to time and be monitored by a health care provider.

If your blood pressure is high, then treatment with certain blood pressure medications may help slow the worsening of aortic regurgitation.

ACE inhibitor drugs and diuretics (water pills) may be prescribed for more moderate or severe symptoms.

In the past, most patients with heart valve problems were given antibiotics before dental work or an invasive procedure, such as colonoscopy. The antibiotics were given to prevent an infection of the damaged heart. However, antibiotics are now used much less often before dental work and other procedures.

You may need to limit activity that requires more work from your heart. Talk to your health care provider. 

Surgery to repair or replace the aortic valve corrects aortic insufficiency. The decision to have aortic valve replacement depends on your symptoms and the condition and function of your heart.

You may also need surgery to repair the aorta if it is widened.

Outlook (Prognosis)

Aortic insufficiency is curable with surgical repair. This can completely relieve symptoms, unless severe heart failure is present or other complications develop. Without treatment, patients with angina or congestive heart failure due to aortic insufficiency do poorly.

Possible Complications

• Abnormal heart rhythms
• Heart failure
• Infection in the heart

When to Contact a Medical Professional

Call your health care provider if:

• You have symptoms of aortic insufficiency
• You have aortic insufficiency and symptoms worsen or new symptoms develop, especially chest pain, difficulty breathing, or edema (swelling)

Prevention

Blood pressure control is very important if you are at risk for aortic regurgitation.

Alternative Names

Aortic valve prolapse; Aortic regurgitation

References

Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, et al; 2006 Writing Committee Members; American College of Cardiology/American Heart Association Task Force. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Sosciety of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:e523-e661.

Carabellow BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 75.

Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 Guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorced by the Society of Cardiovascular Anesthesiologists. Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52:676-685.

Otto CM, Bonow RO. Valvular heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. St. Louis, Mo: WB Saunders; 2011:chap 66.

Update Date: 6/4/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.