The left ventricle of the heart is a muscular chamber. This chamber pumps blood from the heart to the entire body. The blood is pushed through the aortic valve into a major artery, called the aorta. After each heart beat, the valve closes tightly to prevent blood from flowing backwards into the heart.
Aortic insufficiency occurs when the valve does not close tightly enough. Most people with slowly progressive (chronic) disease do not have symptoms and may not need immediate treatment. But, you should talk to your doctor if you think you have this condition. You will need to have tests and get proper treatment. Aortic insufficiency can also occur acutely (rapidly), particularly from infection or
trauma
to the aortic valve.
This requires immediate medical attention.
Aortic insufficiency can be caused by:
- Birth defect in which the aortic valve is uni- (single), bi- (two), or quadricuspid (four valves), instead of the usual tricuspid (three valves)
-
Severe
high blood pressure
-
Bacterial infection of the aortic valve (eg,
syphilis,
chlamydia)
- Injury to the aortic valve
-
Certain inflammatory diseases (eg,
rheumatoid arthritis,
lupus,
temporal arteritis,
Reiter’s syndrome)
- Aneurysm
-
Certain genetic conditions (eg,
brittle bone disease,
Marfan syndrome,
Ehlers-Danlos syndrome,
cystic fibrosis)
-
Heart abnormalities (eg,
septal defect)
- Unknown reasons
Risk Factors
These factors increase your chance of developing aortic insufficiency:
- Family history of aortic insufficiency
- High blood pressure
- Use of drugs (eg, weight loss and appetite suppressant medicines)
Tell your doctor if you have any of these.
Symptoms
These symptoms may be caused by other conditions. Do not assume they are due to aortic insufficiency. Tell your doctor if you have any of these:
- Shortness of breath with activity
- Exercise intolerance
- Dizziness
- Chest pain
- Heart palpitations
-
Heart
arrhythmia
(irregular heartbeat)
- Fainting
- Difficulty breathing when lying flat
Diagnosis
Your doctor will ask about your symptoms and medical history. She will also do a physical exam. Tests may include:
- Chest x-ray
—a test that uses radiation to take a picture of the chest
- Echocardiogram
—a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart and assess it’s valves in detail; usually done on the surface of the chest (called a transthoracic echocardiogram)
- Transesophageal echocardiogram
(TEE)—a type of echocardiogram that looks at the valve in more detail using an ultrasound probe
- Electrocardiogram
(ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle.
- Cardiac catheterization
—a thin tube is inserted into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply
- MRI scan
—a test that uses magnetic waves to make pictures of structures inside the heart
- CT scan
—a type of x-ray that uses a computer to make pictures of structures inside the heart
Treatment
Treatment options depend on the severity and natural history of the valve leakage and its effects on the heart’s size and function. Talk with your doctor about the best treatment plan for you.
The immediate treatment depends on how severe the symptoms are. Surgery is needed in severe cases. In chronic and slowly progressive aortic insufficiency, treatment may involve taking medicine.
Medication
Medicines cannot fix the valve, but they can be used to treat aortic insufficiency. Medicines used may include:
- Diuretics—to treat high blood pressure and rid the body of excess fluids
- Calcium channel blockers—to reduce leaking and, in some cases, delay the need for surgery
- Other medicines (eg, angiotensin converting enzyme inhibitors [ACE inhibitors], angiotensin receptor blockers)
- Antibiotics used before dental and surgical procedures to prevent infection
Depending on your condition, your doctor may schedule routine physical exams and echocardiograms.
If the condition is rapidly declining, surgery is needed.
Surgery
There are several open heart surgeries that can fix leaking valves. The type chosen will depend on the nature of the valve and the expert recommendation of the surgeon. Generally, the valve will be repaired, rather than replaced with an artificial valve.
Prevention
In most cases, this condition cannot be prevented. Ask your doctor if you should take an antibiotic before dental and other procedures. This can help to prevent infection.
