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.

What is the treatment for aortic regurgitation?

Depending on the severity of your condition, you may need surgery to repair or replace your aortic valve. Your provider will evaluate your situation and decide if you need surgery, as well as whether or not you’re a candidate.

Being “a candidate” for surgery is a term healthcare providers use to identify if the benefits of a surgery outweigh its potential risks for you. Many things can raise your surgical risks or complicate healing, including tobacco use and unmanaged underlying conditions. Your provider will talk with you about your risks and whether it’s safe to proceed with surgery.

If you’re not a candidate for valve surgery, your provider may prescribe medications to manage heart failure and improve your quality of life.

How can I reduce my risk of developing aortic regurgitation?

You can’t always prevent heart valve disease. But you can lower your risk by:

• Avoiding tobacco products.
• Avoiding recreational drugs.
• Getting the amount of exercise your healthcare provider recommends.
• Seeing a provider right away when you’re sick or have an infection.
• Taking your medications, including those that treat high blood pressure.

What can I expect if I have aortic insufficiency?

Your outlook depends on many factors. These include:

• When you begin having symptoms.
• How far the condition has progressed.
• Whether you’ve developed heart failure.
• When you receive treatment.
• Your overall health.

Research shows that people who have valve replacement surgery before developing heart failure have a good long-term prognosis. People who have developed heart failure may have a poorer prognosis.

It’s important to talk to your healthcare provider about your outlook. Your provider knows you and your medical history best, and they can use this information to give you an idea of what to expect.

How do I take care of myself?

Follow your healthcare provider’s guidance on self-care, including medications and lifestyle changes. In general, it’s important to take all of your medications as prescribed and at the same time each day. Your provider may also advise you to make lifestyle changes, including:

• Eating a heart-healthy diet such as the Mediterranean diet.
• Exercising regularly (ask your provider how much exercise, and which types, are safe for you).
• Not smoking or using any tobacco products (ask your provider for resources to help you quit).
• Not using recreational drugs, particularly IV drugs, which raise your risk of endocarditis (heart valve infection).
• Taking very good care of your teeth and gums to prevent endocarditis (infection of the heart valves). This includes visiting a dentist every six months.

When should I see my healthcare provider?

If you have aortic regurgitation, it’s crucial that you keep up with your medical appointments so your provider can keep an eye on your condition. Your provider will tell you how often you need to come in.

You’ll need echocardiograms at regular intervals (as often as every six months) so your provider can check your valve and your heart function. It’s essential to go to these appointments so your provider can catch signs of worsening aortic regurgitation. This allows you to receive treatment at the appropriate time and avoid permanent damage to your heart.

If you’ve had heart valve surgery, be sure to adhere to the follow-up schedule your provider gives you. Your provider will monitor you closely to make sure your heart is working well and you don’t develop heart failure or other issues.

Call your provider any time you have new symptoms, worsening symptoms or questions about your condition.

What questions should I ask my provider?

Living with heart valve disease can be stressful. You may have lots of questions about your condition but not know where to start. Here are a few questions you can ask your provider to begin learning more:

• How severe is my aortic regurgitation?
• Do I have any other heart valve problems?
• Do I need treatment, and if so, when?
• What does treatment involve?
• How often do I need to come back for follow-up visits?
• What lifestyle changes should I make to support my heart health?

When should I go to the ER?

Call 911 or your local emergency number if you have symptoms of a heart attack or stroke. These are life-threatening emergencies that require immediate medical care.

A note from Cleveland Clinic

Learning you have a leaky aortic valve can feel scary, and you may wonder what the future will bring. The good news is that advances in medicine allow many people with aortic regurgitation to live long, healthy lives. Talk to your provider about treatment options and what you can expect going forward.