Aortic Insufficiency

(Aortic Regurgitation; Aortic Incompetence)

Definition

The aorta is the main artery carrying oxygen-rich blood from the heart to the body. After each heart beat, the valve closes tightly to prevent blood from flowing backwards into the heart. Aortic insufficiency occurs when the aortic valve does not close tightly enough.There are two types of aortic insufficiency:
  • Acute aortic insufficiency —symptoms develop rapidly, and in severe cases, immediate surgery may be needed
  • Chronic aortic insufficiency —symptoms develop over the course of many months or years
Aortic Valve Insufficiency
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Causes

Aortic insufficiency can be caused by:Sometimes the cause of aortic insufficiency is unknown.

Risk Factors

Factors that may increase your chances of developing aortic insufficiency include:
  • Family history of aortic insufficiency
  • High blood pressure
  • Use of drugs such as weight loss and appetite suppressant medications

Symptoms

Symptoms of aortic insufficiency include:
  • Shortness of breath with activity
  • Exercise intolerance
  • Lightheadedness
  • Chest pain
  • Heart palpitations
  • Irregular heartbeat
  • Fainting
  • Difficulty breathing when lying flat

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.Images may be taken of your heart. This can be done with:

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Treatment

Treatment options depend on the severity and history of the valve leakage. It also depends on its effects on the heart’s size and function. Talk with your doctor about the best treatment plan for you.In chronic and slowly progressive aortic insufficiency, treatment may involve taking medication. Surgery is needed in severe cases.Depending on your condition, your doctor may schedule routine physical exams and echocardiograms.

Medication

Medications cannot fix the valve, but they can be used to treat aortic insufficiency. Medication 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
  • High blood pressure medications
  • Antibiotics used before dental and surgical procedures to prevent infection
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 valve and the knowledge of the surgeon.

Prevention

In most cases, this condition cannot be prevented. Ask your doctor if you should take an antibiotic before dental and other procedures.

RESOURCES

American Heart Association
http://www.heart.org

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

References

Aortic regurgitation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 21, 2014. Accessed August 20, 2014.

Aortic valve stenosis (AS) and aortic insufficiency (AI). American Heart Association website. Available at: http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm%5F307649.pdf. Published 2009. Accessed August 20, 2014.

Coarctation of aorta. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 5, 2014. Accessed August 20, 2014.

Congenital heart defects. Kids Health—Nemours Foundation website. Available at: http://www.kidshealth.org/parent/medical/heart/congenital%5Fheart%5Fdefects.html. Updated January 2012. Accessed August 20, 2014.

Scognamiglio R, Rahimtoola SH, Fasoli G, Nistri S, Dalla Volta S. Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function. N Engl J Med. 1994;331:689.

What are congenital heart defects? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/chd/chd%5Fwhat.html. Updated July 1, 2011. Accessed August 20, 2014.

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