Aortic regurgitation – causes, symptoms, treatment

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Aortic regurgitation is a condition characterized by a backward flow of blood from the aorta to the left ventricle. This happens most often because the valve leaflets are not closed properly. The condition may be acute or chronic, and treatment is usually conservative.

Aortic regurgitation – definition

Aortic regurgitation is a heart defect / condition characterized by abnormal closure of the valve leaflets with the consequence that blood flows backward from the aorta to the left ventricle. A healthy valve opens properly during contraction of the ventricles, allowing blood to flow without problems, and then closes during diastole to prevent blood from flowing back. It is worth mentioning that this type of regurgitation causes the volume of blood in the left ventricle to increase, overloading it, and then impairing its functioning. Aortic regurgitation is more common in men, and the risk of aortic valve disease increases with age.

Does aortic regurgitation interfere with pregnancy?

No, if the patient is not accompanied by heart failure. Also, the use of vasodilators may not be necessary, as a number of hormonal changes occur during pregnancy.

Types of aortic valve insufficiency

Considering the development time of the valve defect,

In relation to the time of development of the valve defect, aortic regurgitation can be acute or chronic.

1. Acute regurgitation accompanies heart and aortic diseases and its course depends on the underlying disease that caused it. It is a great risk because the disturbances in blood flow are sudden and the body is unable to react early.
2. Chronic regurgitation is mainly the result of systemic diseases (connective tissue diseases, atherosclerosis, arterial hypertension), but it can also be the result of a congenital aortic valve defect. In the course of chronic regurgitation, the retreating blood causes the left ventricle to increase in volume, and in extreme cases, along with the development of the defect, pulmonary hypertension may develop. This disease may be asymptomatic for a long time. However, when symptoms do occur, they progress quickly – similar to acute regurgitation. Patients develop shortness of breath, pain in the heart area (at night and after exercise) and palpitations.

Another division of aortic regurgitation relates to the structure that was damaged first. Then the disease is divided into:

1. aortic regurgitation of a primary nature – associated with an abnormal structure of the valve leaflets;
2. aortic regurgitation of a secondary nature – resulting from the dilatation of the ascending aorta or the valve ring.

The causes of aortic regurgitation

The causes of this ailment may be of different nature:

1. congenital – associated with an abnormal valve structure (two-lobed, four-lobed), accompanied by a defect in the interventricular septum or subvalvular stenosis;
2. post-inflammatory – related to valve damage due to inflammatory lesions (e.g. infective endocarditis, RA, rheumatic fever, ankylosing spondylitis);
3. degenerative changes;
4. dilatation of the ascending aorta due to arterial hypertension, inflammation or atherosclerosis – often causes acute regurgitation;
5. medications taken.

Factors that Increase Your Risk of Aortic Regurgitation:

1. sex – regurgitation is more common in men;
2. age – the risk of the disease increases with age;
3. no prophylactic treatment for some ailments, e.g. streptococcal infection;
4. inadequate lifestyle conducive to, e.g., arterial hypertension and atherosclerosis.

Regardless of the cause of aortic regurgitation, there are similar disorders in blood flow. During diastole, the left ventricle fills with blood from the left atrium; in patients with regurgitation, blood leakage from the aorta to the left ventricle through a leaky valve also occurs. The consequence is an overload of the volume of the left ventricle, which in the case of aortic regurgitation can be very large (we are talking about a buffalo heart). The heart muscle, trying to compensate for the ineffective work of the left ventricle, slowly begins to overgrow, which increases the force of contraction; in addition, the heart rate increases. This allows you to maintain an appropriate level of blood volume.

Aortic regurgitation – symptoms

Chronic aortic regurgitation is usually asymptomatic. Fatigue is the most common symptom reported. Other symptoms that may occur in regurgitation include:

1. palpitations;
2. shortness of breath (especially in the course of acute regurgitation);
3. pain in aortic dissection;
4. low tolerance of physical exertion;
5. symptoms of the disease that caused the regurgitation
6. sometimes appear: dizziness and fainting.

Aortic regurgitation – diagnosis

Patients with suspected aortic valve insufficiency are referred to a cardiologist. Initial diagnosis is made based on the complaints reported by the patient and on the basis of the physical examination. The stethoscope examination is the first step in the diagnostic cycle. Physician’s audible diastolic murmurs may suggest aortic regurgitation. In addition, the cardiologist notes changes in blood pressure, which are characterized by a large difference between systolic and diastolic pressure. These differences can be felt in the upper and lower extremities. To obtain a XNUMX% diagnosis, a number of additional tests are performed, such as:

1. EKG (electrocardiographic examination) – thanks to him, it is possible to reveal the characteristic features of left ventricular overload; sometimes abnormal heart rhythms are visible;
2. X-ray – in patients with chronic regurgitation, X-ray examination will show left ventricular enlargement and widening of the aortic arch and ascending aorta; in acute regurgitation, examination may reveal congestion in the pulmonary circulation;
3. echocardiography – this is a basic diagnostic test that not only detects the defect, but also allows you to assess how advanced it is. Thanks to the examination, it is possible to obtain the dimensions of the heart cavities and the ascending aorta, systolic activity of the left ventricle and possible damage to the valve leaflets. Typically, the echo of the heart is performed through the chest, however, in some patients it may be necessary to test with an esophageal probe;
4. computed tomography / stress test / magnetic resonance imaging / cardiac catheterization – these tests are performed only in special cases.

Aortic regurgitation – treatment

Treatment of chronic regurgitation is conservative. Then, pharmacological agents are implemented to expand the vessels. They are used in patients with severe chronic regurgitation and in people who did not qualify for surgery. In addition, pharmacological treatment is used before the planned surgery in order to normalize the circulation.

In turn, invasive treatment of aortic regurgitation consists in replacing the damaged valve with an artificial valve. Surgical procedures are performed in patients with acute symptoms, with a dilated ascending aorta and severe regurgitation with concomitant clinical symptoms. Sometimes an ascending aorta prosthesis is implanted simultaneously.

The effectiveness of the surgical method depends on how severe the defect and the circulatory failure are. Patients with an artificial valve should always remember about thromboprophylaxis and prophylaxis of infective endocarditis.

How to prevent aortic regurgitation?

1. A healthy lifestyle is important. It is worth implementing physical activity appropriate for our age and health. Even 30 minutes of walking / swimming a day reduces the risk of cardiovascular disease.

2. Diet. The basis of a healthy diet should be fiber, which is found in large amounts in vegetables and fruits, and in some products, e.g. in whole grain bread or groats. Eating red meat has a negative effect on our body, so it is worth replacing it with poultry and fish. Give up excessive salting of dishes and sweets.

3. Stop smoking!

4. Use rheumatic fever prophylaxis. Use penicillin-based antibiotic therapy for streptococcal pharyngitis. If you have rheumatic fever – prevent it from coming back.