Our heart has four chambers that are divided by walls made up of heart tissue. These four chambers include two atria and two ventricles. When the heart beats, the atria contracts and pushes the blood into the ventricles. Then, the ventricles contract and pump the blood outside the heart, into the aorta and pulmonary artery. In order to prevent the backflow of the blood, there are flaps or valves present between the atria and ventricles as well as the ventricles and the large arteries. These valves are very important to help the blood flow in one direction and not flow back.
There are basically four valves, which include the aortic valve, pulmonary valve, mitral and tricuspid valve. The mitral and aortic valves are commonly affected with valve problems and diseases. We shall discuss information related to aortic regurgitation in the following paragraphs.
The aortic valve has three cusps or leaflets. These cusps include a left cusp, right cusp and a posterior cusp. When the pressure in the left ventricle increases more than the pressure in the aorta during the ventricular systole, it causes the aortic valve to open. This allows the blood from the left ventricle to flow into the aorta. When the ventricular systole ends, it causes a significant drop in the pressure in the left ventricle. This decrease in pressure causes the aortic valve to close as the aortic pressure increases.
There are two types of conditions that affect the aortic valve. These include aortic stenosis and aortic regurgitation. In aortic stenosis, the valve fails to open up, causing decrease in blood supply outside the heart.
Aortic regurgitation is the condition where the aortic valve is not able to close properly, causing a backflow of the blood in the wrong direction. The blood that was pumped into the aorta flows back into the left ventricle. This occurs due to some abnormalities of the aortic valve or at the start of the aorta. Aortic regurgitation affects people in the age group of 30 and 60 years and is more common in men than women.
There are two types of aortic regurgitation, acute and chronic. In case of acute aortic insufficiency, it occurs in case of acute perforation of the aortic valve due to endocarditis. It is a medical emergency, if the person develops severe acute aortic insufficiency. If the person is not taken in for immediate surgery, it can lead to death.
Chronic aortic insufficiency, the left ventricle adapts itself and compensates the volume overload. The pressure in the left ventricle will revert to normal and reduce the chances of heart failure. The patient remains asymptomatic during the latent period. But after some time, the left ventricle turns decompensated. Some may experience congestive heart failure symptoms and some remain asymptomatic. During this phase, one may have to undergo an aortic valve replacement surgery.
Aortic regurgitation is often caused due to rheumatic fever. In some cases, it is often due to the presence of 2 cusps instead of 3 cusps. Severe high blood pressure (more than 110 Hg) can lead to aortic insufficiency. Some of the other causes of aortic regurgitation include:
- Spinal arthritis
- Marfan syndrome
- Aortic stenosis
- Syphilitic aortitis
- Osteogenesis imperfect
- Aortic dissection
- Behcet’s disease
- Ehlers-Danlos syndrome
- Systemic lupus erythematosus
Risk factors for developing aortic regurgitation include:
- Family history of aortic regurgitation
- High blood pressure
- Use of medications and drugs for weight loss and appetite suppressants
- Aortic valve damage
- Congenital heart valve defect
Symptoms of aortic regurgitation include:
- Chest pain or tightness that reduces when one rests
- Heart palpitations
- Shortness of breath
- Fainting spells
- Swelling of ankles and feet
- Difficulty breathing when one lies down
- Irregular pulse
- Heart murmur
The diagnosis of aortic regurgitation involves physical examination as well as diagnostic tests. The doctor will take a complete medical history of the patient. He/she will conduct a physical examination and check for pulse and blood pressure that give indications of aortic regurgitation like:
- Difference between diastolic and systolic blood pressure reading
- Visible pulsing of the artery in the neck
- Unusual forceful heartbeat sound
- ‘water-hammer’ pulse
- Corrigan’s pulse
- Collapsing pulse
- Bisferiens’s pulse
- Traube’s sign
- Duroziez’s sign
- de Musset’s sign
The diagnostic tests conducted include:
- Transthoracic echocardiography
- Chest X-ray
- Cardiac chamber catheterization
Treatment of aortic regurgitation includes medical and surgical methods, depending on the individual patient case. Medical treatment is carried out in case of patients who are stable and remain asymptomatic. Patients are given vasodilators, especially patients with hypertension. Other methods include following low sodium diet, diuretics, digoxin, calcium blockers and avoiding strenuous activities.
Surgical treatment involves aortic valve replacement.
If one is diagnosed with aortic regurgitation, then one needs to make some lifestyle changes. One should quit smoking, follow a diet that is healthy for the heart, take up walking and maintain a healthy body weight. In most cases, medications and maintaining a low blood pressure help control the advancement of aortic regurgitation. Speak to your doctor and find out what’s best for you.
Written by: Saptakee sengupta
Date last updated: April 07, 2015