Aortic Regurgitation (Insufficiency)

Leaking of the aortic valve

Aortic insufficiency is a heart valve disease in which the aortic valve does not close tightly. This leads to the backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (a chamber of the heart).

If you have aortic insufficiency, your heart may be able to compensate for some time. Even if you have no symptoms, it is important follow up with an echocardiogram at least once a year to detect if your heart is starting to have trouble compensating.

Causes of Aortic Regurgitation (Insufficiency)

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

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 valve problems, such as bicuspid valve
  • Endocarditis
  • High blood pressure
  • Marfan syndrome
  • Reiter syndrome (also known as reactive arthritis)
  • Syphilis
  • Systemic lupus erythematosus

Symptoms of Aortic Regurgitation (Insufficiency)

Aortic insufficiency often has no symptoms for many years.

Symptoms may occur slowly or suddenly and can include:

  • Bounding pulse
  • Chest pain, angina type (rare) under the chest bone. The pain may move to other areas of the body, most often the left side of the chest. You may also experience pain described as crushing, squeezing, pressure or tightness with pain increasing with exercise and going away with rest.
  • Fainting
  • Fatigue
  • Palpitations
  • 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

Signs of aortic insufficiency may include:

  • A heart murmur
  • A 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 insufficiency may be seen on:

  • Aortic angiography
  • Echocardiogram - ultrasound examination of the heart
  • Left heart catheterization
  • MRI of the heart
  • Transesophageal cardiogram (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.