ALSO KNOWN AS
Aortic regurgitation
DESCRIPTION
* The heart pumps blood from the left ventricle (left lower chamber) of the heart to the rest of the body by way of a large blood vessel known as the aorta. The aortic valve, located between the left ventricle and the aorta, opens when the ventricle pumps blood to the aorta, and closes (passively) when at rest (i.e., between heartbeats). If the valve leaflets are damaged or fail to close properly, blood leaks back from the aorta into the left ventricle between heartbeats. This is known as aortic regurgitation.
SYMPTOMS
* Usually none until age 40-50
* Fatigue
* Shortness of breath on exertion
* Shortness of breath while resting prone
* Chest pain
* Lightheadedness
CAUSE
* Congenital bicuspid aortic valve (person is born with only two aortic valve leaflets, instead of the normal three)
* Rheumatic heart disease (caused by untreated "strep throat" in childhood)
* Hypertension
* Infective endocarditis
* Marfan's Syndrome
* Ankylosing Spondylitis
* Reiter's Syndrome
* Aortic Dissection
* Syphilis
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HOW THE DIAGNOSIS IS MADE
* Chronic (slow onset) aortic regurgitation, e.g., rheumatic heart disease --
1. Decreased diastolic blood pressure
2. Wide pulse pressure (large difference between systolic and diastolic)
3. Pulse has a rapid rise and fall (known as a Corrigan's pulse)
4. Diastolic murmur over a partially compressed femoral artery
5. Nail bed capillaries show pulsations
6. Apical heart impulse is prominent
7. Heart reveals a high-pitched decrescendo (decreasing in loudness) diastolic murmur in the aortic area. An Austin Flint murmur may be present (low-pitched, mid or late diastolic murmur).
8. Electrocardiogram shows left ventricular hypertrophy
9. Chest X-Rays shows an enlarged heart (cardiomegaly)
* Acute aortic regurgitation, e.g., infective endocarditis --
1. Sudden onset of aortic regurgitation murmur
2. Lungs may reveal crackles of Pulmonary Edema
* Echocardiogram -- reveals the valve abnormality, and Doppler studies show the degree of regurgitation.
* Scintigraphic studies can asses left ventricular function
* Cardiac catheterization is often helpful
TREATMENT
* Chronic --
1. Vasodilator medications such as ACE inhibitors, hydralazine, and nifedipine can decrease the severity of the regurgitation.
2. Beta-blocker medications may slow progression in those with Marfan's Syndrome.
3. Surgical valve replacement in those with symptoms or significant left ventricular dysfunction
* Acute --
- Usually caused by infective endocarditis -- surgical replacement of the valve is usually needed. Vasodilators may temporarily stabilize the condition.
IF YOU SUSPECT THIS CONDITION
* Acute aortic regurgitation -- this is a life-threatening medical condition. Seek immediate emergency medical treatment.
* Chronic aortic regurgitation -- this condition needs to be followed carefully by your physician. A cardiologist is often consulted.
MISCELLANEOUS
* Special Consideration
- Persons with aortic regurgitation should have antibiotic prophylaxis to prevent infective endocarditis. This includes dental, respiratory, esophageal, gastrointestinal, and genitourinary procedures.
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