Aortic insufficiency (patient information)
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# Overview
Aortic insufficiency is a heart valve disease in which the aortic valve does not close tightly. This leads to the backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (a chamber of the heart).

# What are the symptoms of Aortic insufficiency?
Aortic insufficiency often has no symptoms for many years. Symptoms may occur slowly or suddenly and include the following:
- Bounding pulse
- Chest pain, angina type (rare)
Under the chest bone; pain may move to other areas of the body, most often the left side of the chest
Crushing, squeezing, pressure, tightness
Pain increases with exercise, and goes away with rest
- Under the chest bone; pain may move to other areas of the body, most often the left side of the chest
- Crushing, squeezing, pressure, tightness
- Pain increases with exercise, and goes away with rest
- Fainting
- Fatigue, excessive tiredness
- Irregular, rapid, racing, pounding, or fluttering pulse
- Palpitations (sensation of the heart beating)
- Shortness of breath with activity or when lying down
- Swelling of the feet, legs, or abdomen
- Weakness, more often with activity

# What causes Aortic insufficiency?
Aortic insufficiency can result from any condition that keeps the aortic valve from closing all the way. A small amount of blood comes back each time the heart beats.
The condition causes widening (dilation) of the left lower chamber of the heart. Larger amounts of blood leave the heart with each squeeze or contraction. This leads to a strong and forceful pulse (bounding pulse). Over time, the heart becomes less able to pump blood to the body.
In the past, rheumatic fever was the main 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:
- Ankylosing spondylitis
- Aortic dissection
- Congenital (present at birth) valve problems
- Endocarditis
- High blood pressure
- Marfan syndrome
- Reiter syndrome
- Syphilis
- Systemic lupus erythematosus

# Diseases with similar symptoms
The symptoms of mitral valve prolapse, Tricuspid regurgitation and mitral regurgitation have similar to those of aortic insufficiency.

# Who is at highest risk?
Aortic insufficiency affects approximately 5 out of every 10,000 people. It is most common in men between the ages of 30 and 60.

# Diagnosis
Signs may include:
- A heart murmur when the health care provider listens to the chest with a stethoscope
- A very forceful beating of the heart
- The head may bob 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:
- Aortic angiography
- Doppler ultrasound
- Echocardiogram - ultrasound examination of the heart
- Left heart catheterization
- Transesophageal echocardiography (TEE)
- An ECG or chest x ray may show swelling of the left lower heart chamber.
Lab tests cannot diagnose aortic insufficiency, but they may be used to rule out other disorders or causes.

# When to seek urgent medical care?
Call your health care provider if:
- You have symptoms of aortic insufficiency.
- You have aortic insufficiency and symptoms worsen or new symptoms develop, especially chest pain, difficulty breathing, or edema (swelling).

# Treatment options
- If there are no symptoms or if symptoms are mild, you may only need to get an echocardiogram from time to time and be monitored by a health care provider.
- If your blood pressure is high, then treatment with certain blood pressure medications may help slow the worsening of aortic regurgitation.
- If symptoms are severe, you may need to stay in the hospital. ACE inhibitor drugs and diuretics (water pills) may be prescribed for more moderate or severe symptoms. These medications may also be used in people with mild symptoms to prevent the symptoms from worsening.
- In the past, most patients 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 before dental work and other procedures.
- You may need to limit activity that requires more work from your heart. Talk to your health care provider. Moderate activity restriction may be recommended. People with severe symptoms should avoid strenuous activity.
- Surgery to repair or replace the aortic valve corrects aortic insufficiency. The decision to have aortic valve replacement depends on your symptoms and condition and function of the heart. Surgery to repair the aorta may be required if it is widened.

# Where to find medical care for Aortic insufficiency?
Directions to Hospitals Treating Aortic Insufficiency

# Prevention
- Blood pressure control is very important if you are at risk for aortic regurgitation.
- Treating strep infections promptly to prevent rheumatic fever, which can lead to aortic insufficiency.
- Aortic insufficiency caused by other conditions often cannot be prevented but some of the complications can be. Notify your health care provider or dentist about any history of heart valve disease before treatment for any condition. Any dental work, including cleaning, and any invasive procedure can introduce bacteria into the bloodstream. This bacteria can infect a weakened valve, causing endocarditis. Follow the provider's treatment recommendations for conditions that may cause valve disease. Notify the provider if there is a family history of congenital heart disease.

# What to expect (Outlook/Prognosis)?
Aortic insufficiency is curable with surgical repair. This can completely relieve symptoms unless severe heart failure is present or other complications develop. Without treatment, patients with angina or congestive heart failure do poorly.

# Possible complications
- Abnormal heart rhythms
- Heart failure
- Infection in the heart

# Sources
CME Category::Cardiology