Aortic Valve Regurgitation

What is aortic valve regurgitation?

Aortic valve regurgitation occurs when the aortic valve one of the four valves in the heart fails to function properly and allows blood to flow backward through it. When some blood flows back from the aorta into the heart, it puts pressure on the heart and decreases the amount of blood flowing to the rest of the body.

There are two main types of aortic valve regurgitation, acute (sudden-onset) and chronic (long-term), that may present with different symptoms. Acute symptoms include sudden paleness, dizziness, loss of consciousness, shortness of breath, chest pain or back pain. Chronic symptoms present with exertion, such as shortness of breath, chest pain, and an uncomfortable pounding of the heart.

Treatments include medication and surgery to repair the aortic valve.

You should visit your primary care physician within the next 24 hours if you are feeling fatigue, weakness, shortness of breath, chest pain, irregular pulse, or sensations of a rapid, fluttering heartbeat. Depending on the severity, you may or may not need treatment.

Symptoms of aortic valve regurgitation

The symptoms of aortic valve regurgitation may differ depending on whether you have acute or chronic aortic valve regurgitation. Chronic aortic valve regurgitation usually does not cause any symptoms until the disease is advanced.

Acute aortic valve regurgitation symptoms

Symptoms of acute aortic valve regurgitation include:

• Sudden paleness, dizziness, or loss of consciousness: This may occur if the aortic valve regurgitation prevents the heart from delivering enough blood to the rest of the body and the brain.
• Sudden onset shortness of breath: This can occur if the aortic valve regurgitation causes blood to back up into the lungs.
• Sudden chest pain or back pain: This may occur if the acute aortic valve regurgitation is caused by aortic dissection. The pain is usually sharp, and severe, and may be described as "tearing."

Chronic aortic valve regurgitation symptoms

Symptoms of chronic, or long-term, aortic valve regurgitation include:

• Shortness of breath on exertion: Some people with chronic aortic valve regurgitation may develop shortness of breath. This can occur because, over time, the heart enlarges in response to the aortic valve regurgitation and becomes weaker, causing blood to back up into the lungs, or congestive heart failure (CHF). At first, you may experience shortness of breath only on exertion. As the disease progresses, you may experience shortness of breath when lying flat and may be woken up in the middle of the night gasping for air.
• Chest pain on exertion: This can occur because the backflow of blood through the aortic valve reduces the amount of blood being supplied to the heart itself. The chest pain is usually a dull pain or pressure felt in the left side of the chest and may spread to the arms or neck. The chest pain may also occur at night, when the heart rate normally slows, further exacerbating the insufficient blood supply to the heart.
• Uncomfortable feeling of pounding of the heart: Some people with chronic aortic valve regurgitation may be aware of an uncomfortable feeling of pounding of the heart, or palpitations, which may be more noticeable when lying on the left side.

What causes aortic valve regurgitation?

The two types of aortic valve regurgitation, acute (sudden-onset) and chronic (long-term), have different causes. Acute aortic valve regurgitation can be caused by infection, tears in the aorta or damage to the aortic valve.

Acute aortic valve regurgitation

The sudden-onset form of this condition involves causes such as:

• Infection of the aortic valve: Bacteria, especially in the bloodstream, can damage the aortic valve (known as endocarditis) and prevent it from properly closing, causing aortic valve regurgitation.
• A tear in a part of the wall of the aorta: This can cause aortic valve regurgitation, especially if the tear fills with blood and dilates the area around the aortic valve, in which the aortic valve cannot properly close. This can also happen if the tear extends into part of the aortic valve and dislocates it from its normal position.
• Trauma or injury to the chest: Damage to the aortic valve can cause aortic regurgitation. This most commonly occurs after blunt trauma to the chest or rapid deceleration, such as in an auto accident.
• Damage during a procedure involving the aortic valve: The aortic valve can be inadvertently damaged during procedures involving the aortic valve. Examples of procedures that have this risk include procedures to dilate or replace the aortic valve.

Chronic aortic valve regurgitation

The long-term form of this condition can be caused by:

• Inflammation of the heart after an infection: Some people who have an infection caused by the bacterium Streptococcus pyogenes (such as strep throat) but go untreated may develop inflammation of the heart, called rheumatic heart disease. This can damage the heart valves, including the aortic valve, causing aortic valve regurgitation.
• Calcium deposits on the aortic valve: The calcium deposits usually thicken the aortic valve and cause the opening to narrow, but they can also prevent the aortic valve from properly closing, causing aortic valve regurgitation. This usually occurs in elderly people, because the process happens over time.
• A bicuspid aortic valve: Most people are born with an aortic valve that has three leaflets (a tricuspid aortic valve). However, some people are born with an aortic valve with only two leaflets, known as a bicuspid aortic valve. Bicuspid aortic valves can accumulate calcium deposits more easily than tricuspid aortic valves. Therefore, people born with bicuspid aortic valves can develop aortic valve regurgitation at a younger age than people with tricuspid aortic valves.
• Dilation of the aorta near the aortic valve: This dilation near the root of the aortic valve can happen due to a number of reasons, including uncontrolled high blood pressure, certain connective tissue disorders, or inflammation of the blood vessels. Dilation of the root of the aorta may prevent the aortic valve from properly closing, leading to aortic valve regurgitation.

Treatment options and prevention

The treatment for aortic valve regurgitation may differ depending on whether the aortic valve regurgitation is acute or chronic. The definitive treatment for all types of aortic valve regurgitation is surgery to repair or replace the aortic valve. However, in some cases, medications may be used to control aortic valve regurgitation symptoms until surgery can be done.

Supportive medications for acute aortic valve regurgitation

People with acute aortic valve regurgitation will usually have significant symptoms and require emergent surgery. However, if surgery cannot be immediately done, your physician may administer medications to support you.

Supportive medications for chronic aortic valve regurgitation

People with chronic aortic valve regurgitation may develop symptoms but not have severe enough disease to warrant surgery. In these cases, your physician may recommend a number of medications to help reduce symptoms. A few options include:

• Furosemide (Lasix)
• Lisinopril (Prinivil)
• Losartan (Cozaar)
• Metoprolol (Toprol)
• Spironolactone (Aldactone)

Surgery to repair or replace the aortic valve

Open heart surgery is usually required, but some treatment centers may offer a procedure to replace the aortic valve through a catheter inserted into a blood vessel.

When to seek further consultation

You should seek medical attention if you develop concerning chest symptoms, such as those described below.

If you develop any symptoms of aortic valve regurgitation

You should see your physician if you experience chest pain, shortness of breath, or an uncomfortable pounding sensation in the chest. If you have sudden severe chest or back pain, sudden onset shortness of breath, dizziness or loss of consciousness, you should go the emergency room or call an ambulance, as this may be a sign of acute aortic valve regurgitation, which is a medical emergency.