Aortic insufficiency is a disease of the aortic heart valve where it no longer functions adequately to control the flow of blood from the left ventricle into the aorta. The valve weakens or balloons, preventing the valve from closing tightly and leads to backward flow of blood from the aorta into the left ventricle of the heart. This can result from any condition that weakens the aortic valve. The condition causes widening of the left lower chamber of the heart and can get worse with time. As this area of the heart becomes more dilated (widened), it is less able to pump blood as effectively to the aorta. The heart will try to compensate by sending out larger amounts of blood with each contraction leading to a strong and forceful pulse. Overtime, this extra workload can cause the heart to enlarge and may lead to heart failure.
Causes include rheumatic fever, high blood pressure, Marfan’s syndrome, aortic dissection, ankylosing spondylitis, Reiter’s syndrome, syphilis, and lupus among other disorders. Aortic insufficiency affects approximately 5 of every 10,000 people and is most common in men between the ages of 30 to 60.
Symptoms:
Aortic insufficiency may not show symptoms for several years and then may come on gradually or suddenly. Symptoms may include palpitations, a pounding or irregular pulse, fainting, weakness (especially with activity), shortness of breath (with activity or lying down), excessive tiredness, or chest pain.
Risk Factors:
Aortic insufficiency can result from any condition that weakens the aortic valve. The condition causes dilation (widening) of the left lower chamber of the heart, which continues to get worse with time. As this area of the heart becomes dilated, it is less able to pump blood to the rest of the aorta. The heart tries to make up for the problem by sending out larger amounts of blood with each heart contraction. This leads to a strong and forceful pulse (bounding pulse).
In the past, rheumatic fever was the primary 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:
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Ankylosing spondylitis
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Aortic dissection
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Congenital (present at birth) valve problems
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Endocarditis
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High blood pressure
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Marfan syndrome
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Reiter syndrome
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Syphilis
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Systemic lupus erythematosus
How it is Diagnosed:
A murmur may be detected with the stethoscope. Hyperdynamic or forceful beating of the heart may be felt with palpation (examination by hand). There may be a widened pulse pressure (the difference between systolic and diastolic blood pressure). There may be signs of fluid on the lungs.
Aortic insufficiency may be seen using the following tests:
- An echocardiogram (uses ultrasound waves to record images of the heart)
- A transesophageal echocardiogram (TEE)
- Doppler ultrasound (measures how severe the regurgitation is)
- Aortic angiography
- Left heart catheterization
- Left ventricle enlargement may show on an electrocardiogram (ECG) or chest XRay
Treatment Options:
If there are no symptoms or the symptoms are mild, you may only need to get an echocardiogram form time to time and be monitored by your health care provider.
If symptoms are severe, ACE inhibitor drugs and diuretics (water pills) may be prescribed. Moderate activity restriction may be recommended. People with severe symptoms should avoid strenous activity. Call your health care provider if you have aortic insufficiency and symptoms worsen or new ones develop. Your health care provider needs to know changes, especially if there is any chest pain, difficulty breathing, or swelling (edema).
Surgery to repair or replace the valve can correct the insufficiency. Two types of artificial heart valves are available: mechanical and bioprosthetic (specially treated pig valves or valves made from other body tissue). Surgery to replace the aortic valve at the proper time can improve both the quality and length of life.
Prevention includes treating strep infections promptly to prevent rheumatic fever.