Aortic insufficiency is a heart valve disease in which the aortic valve does not close tightly. This allows blood to flow from the aorta (the largest blood vessel) into the left ventricle (a chamber of the heart).
Aortic valve prolapse; Aortic regurgitation; Heart valve - aortic regurgitation; Valvular disease - aortic regurgitation; AI - aortic insufficiency
Any condition that prevents the aortic valve from closing completely can cause this problem. When the valve does not close all the way, a small amount of blood comes back each time the heart beats.
This makes the heart have to work harder to force out enough blood. The left lower chamber of the heart widens (dilates) and the heart beats very strongly (bounding pulse). Over time, the heart becomes less able to supply enough blood to the body.
In the past, rheumatic fever was the main cause of aortic insufficiency. The use of antibiotics to treat strep infections has made rheumatic fever less common. Therefore, aortic insufficiency is more commonly due to other causes. These include:
- Ankylosing spondylitis
- Aortic dissection
- Congenital (present at birth) valve problems, such as bicuspid valve
- High blood pressure
- Marfan syndrome
- Reiter syndrome (also known as reactive arthritis)
- Systemic lupus erythematosus
- Trauma to the chest
Aortic insufficiency is most common in men between the ages of 30 and 60.
The condition often has no symptoms for many years. Symptoms may come on slowly or suddenly. They may include:
- Bounding pulse
- Chest pain similar to angina (rare)
- Palpitations (sensation of the heart beating)
- Shortness of breath with activity or when lying down
- Waking up short of breath some time after falling asleep
- Swelling of the feet, legs, or abdomen
- Uneven, rapid, racing, pounding, or fluttering pulse
- Weakness that is more likely to occur with activity
Exams and Tests
Signs may include:
- Heart murmur that can be heard through a stethoscope
- 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 tests such as:
- Aortic angiography
- Echocardiogram - ultrasound examination of the heart
- Left heart catheterization
- MRI of the heart
- Transthoracic echocardiogram (TTE) or transesophageal echocardiogram (TEE)
A chest x-ray may show swelling of the left lower heart chamber.
Lab tests cannot diagnose aortic insufficiency. However, they may help rule out other causes.
You may not need treatment if you have no symptoms or only mild symptoms. However, you will need to see a health care provider for regular echocardiograms.
If your blood pressure is high, you may need to take blood pressure medicines to help slow the worsening of aortic regurgitation.
Diuretics (water pills) may be prescribed for symptoms of heart failure.
In the past, most people 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.
You may need to limit activity that requires more work from your heart. Talk to your 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.
Surgery can cure aortic insufficiency and relieve symptoms, unless you develop heart failure or other complications. People with angina or congestive heart failure due to aortic insufficiency do poorly without treatment.
Complications may include:
- Abnormal heart rhythms
- Heart failure
- Infection in the heart
When to Contact a Medical Professional
Call your provider if:
- You have symptoms of aortic insufficiency.
- You have aortic insufficiency and your symptoms worsen or new symptoms develop (especially chest pain, difficulty breathing, or swelling).
Blood pressure control is very important if you are at risk for aortic regurgitation.
Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 75.
Nishimura. RA, Otto CM, Bownow RO, et al. 2014 AHA/ACC Guideline 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. J Thorac Cardiovasc Surg. 2014;148(1):e1-e132. PMID: 24939033 www.ncbi.nlm.nih.gov/pubmed/24939033.
Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 63.