February 14, 2022

Understanding aortic valve regurgitation

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What are the symptoms and what tests can identify the problem?

Aortic valve regurgitation is when the aortic valve, one of four valves in the heart, leaks. The aortic valve is on the left side of the heart. It sits between the left lower chamber (left ventricle) and the large blood vessel that sends blood to the body (aorta). Valves in the heart help blood flow through the heart in the correct direction. Normally, the aortic valve helps blood flow from the left ventricle to the aorta. When the heart squeezes, the valve is pushed open to let blood flow out of the heart. When the heart relaxes, the valve closes and prevents blood from flowing backwards into the heart. 

When the aortic valve lets blood seep back into the heart

With aortic valve regurgitation, some blood leaks back into the left ventricle when the valve closes. Less blood flows forward into the aorta to supply the body. The backflow adds to the volume of blood in the heart itself (volume overload). This can quickly lead to high pressures in the heart and lungs, which can cause you to feel short of breath. Over time, the volume overload makes the heart work harder to pump blood and can lead to heart failure. This may occur with moderate to severe aortic valve regurgitation. 

There are two types of aortic valve regurgitation:

  • Acute aortic valve regurgitation. The valve starts to leak suddenly. The heart doesn’t have time to get used to the leaking. Sudden severe aortic valve regurgitation is a medical emergency. Symptoms often start abruptly and are severe. 
  • Chronic aortic valve regurgitation. The valve becomes leaky over time. The heart has time to get used to the leak. Therefore symptoms may be more subtle, gradually getting worse over time because the heart and the body are able to adjust to the change in blood flow. 

What causes aortic valve regurgitation?

The causes of aortic valve regurgitation can include: 

  • Weakening of the valve from aging 
  • High blood pressure
  • Congenital valve defects (problems that were present at birth) 
  • Infections, such as an infection of the heart lining (infective endocarditis) 
  • Valve damage from untreated strep infections, such as strep throat (rheumatic heart disease) 
  • Problems with the aorta, such as a tear in the vessel wall (dissection) or weakening and ballooning out of the vessel wall 
  • Injuries to the chest

Symptoms of aortic valve regurgitation

You may not have any signs if you have mild aortic regurgitation. If your condition is more severe or if it gets worse over time, you may have symptoms such as: 

  • Shortness of breath with exercise or activity, or when lying down
  • Chest pain
  • Tiredness (fatigue)
  • Feeling the heart beat faster or harder (palpitations)
  • Swelling in your legs, belly (abdomen), and the veins in your neck

Sudden severe aortic valve regurgitation is a medical emergency. Call 911 or get medical help right away. Signs of this may include: 

  • Pale skin, loss of consciousness, fast breathing, and fast heartbeat (symptoms of shock) 
  • Severe dizziness
  • Severe shortness of breath
  • Chest pain
  • Abnormal heart rhythm (arrhythmia)

Diagnosing aortic valve regurgitation

Your doctor will ask about your medical history and symptoms. A physical exam will include listening to your heart with a stethoscope. This will let your health-care provider hear whether you have an abnormal heart sound (a heart murmur). You may also have diagnostic tests such as: 

  • Electrocardiography (ECG). Sticky pads (electrodes) are put on your chest. Wires are attached and connected to a machine. The machine checks your heart rhythm. 
  • Chest X-ray. This test uses a small amount of radiation to make pictures of your heart and lungs. This is done to check for any changes such as an enlarged heart or fluid in the lungs. 
  • Transthoracic echocardiography (TTE). Sound waves are used to make pictures of your heart using a wand (transducer) placed over your chest. 
  • Transesophageal echocardiography (TEE). This is another way of using sound waves to make pictures of your heart. The health-care provider passes a transducer down your esophagus to get pictures. This type of test may be used when certain pictures of the heart are needed. For example, it may be used to check for problems with the aorta. 
  • CT scan. This test uses a series of X-rays and a computer to create detailed pictures of your heart and aorta. 
  • Cardiac MRI (CMR). Magnets, radio waves and a computer are used to make detailed pictures of your heart and aorta. 
  • Exercise stress test. During this test, an ECG is done while you exercise. This checks how your heart reacts to stress. Pictures of the heart may be taken during this test. 
  • Cardiac catheterization (heart cath), aortography or coronary angiography. These invasive tests may be needed if other test results are not clear. They may also be done if surgery is planned.
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Vanderbilt University Medical Center is a leader in treating heart valve disease with the newest transcatheter techniques. Vanderbilt’s team includes general cardiologists, interventional cardiologists and cardiac surgeons, all with advanced training and expertise in structural heart and valve disease. They treat patients with diseases of the aortic, mitral or tricuspid valve, from the routine to the complex.

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