Aortic Regurgitation

What is aortic regurgitation?

Aortic regurgitation (ree-ger-jih-TA-shun) or AR, is also known as aortic insufficiency (AI) (in-suh-FISH-in-c). AR is when the aortic valve in the heart does not close completely. Because the valve never closes completely, blood leaks backward from the aorta into the left ventricle (VEN-trik-ull).

Where is the aortic valve?

• The heart has 4 chambers (rooms). The two upper chambers are called atria (A-tree-uh) and the two lower chambers are called ventricles. When the heart "beats", the atria pump blood into the ventricles. The ventricles then pump blood out of the heart. The right ventricle pumps blood into the pulmonary artery then into the lungs to get oxygen. The left ventricle pumps the blood with oxygen into the aorta and out to the body.
  
  
• There are valves (doors) between the chambers that open and close to direct blood flow through the heart. The aortic valve is between the left ventricle and the aorta. The aortic valve is made up of 3 "cusps". The cusps come from the sides and top of the valve and meet in the middle. As the heart beats, the aortic valve opens to let blood flow from the left ventricle into the aorta. When the heart rests between beats, the aortic valve should close and keep blood from flowing backward into the left ventricle.

What happens to my heart when I have AR?

• When blood leaks backward from the aorta into the left ventricle your body may not get enough blood. Your heart tries to make up for the smaller amount of blood pumping into the body by pumping harder. If your AR is not very bad, your heart may be able to pump harder for your whole life. But, AR might make your heart weaker over time.
  
  
• Your aortic regurgitation may slowly get worse. If your heart gets weaker, you may start having symptoms. You may notice that you can feel your heartbeat--especially in your neck or head. You may have trouble breathing, or have chest pain when you are exercising or climbing stairs. You may have trouble breathing when you lie down flat. Your feet and ankles may swell.

What causes aortic regurgitation?

Aortic regurgitation usually happens because the cusps were deformed before you were born or they became that way because of disease or accident. Another cause of aortic regurgitation is the aortic ring, the place the cusps are attached to, has gotten wider. This usually happens because you get older or have a disease or accident. Following is a list of some causes of AR. Ask your caregiver if you want more information about any of these causes:

• Rheumatic (rew-MAH-tik) fever.
  
  
• Infective (in-FEK-tiv) endocarditis (end-o-kar-DI-tis).
  
  
• Heart valve problems at birth. The aortic valve may have one or two cusps instead of three.
  
  
• The cusps may be deformed.
  
  
• Problems in the aorta that force blood backwards into the left ventricle.
  
  
• Deterioration (breaking down) of the valve with age.
  
  
• Injury to the heart, from an accident or a heart attack.
  
  
• Past use of certain diet drugs.
  
  
• Other diseases.

What are the signs and symptoms of AR?

Often there are no signs or symptoms of AR for many years. In time, you may have one or more of the following signs and symptoms:

• Hearing your heart beating, especially in your head and neck.
  
  
• Shortness of breath during exercise or activities like climbing stairs.
  
  
• Shortness of breath when you lie down or at night.
  
  
• Waking up at night coughing or gasping for air.
  
  
• Swelling feet and ankles.
  
  
• Feeling faint or actually fainting during exercise or activities.
  
  
• Heart murmur (extra sound) when caregivers listen to your heartbeat.

What tests may be done?

Many tests may be done to learn how your AR is doing. You may have some or all of the following tests. These tests may be done more than once as your AR is being treated.

• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Echocardiogram: This test is a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
  
  
• Cardiac blood pool imaging: This test shows how well your heart is pumping. It can also be called a "gated blood pool scan" or a MUGA scan. You are given a small, safe amount of radioactive dye in an IV. Caregivers then take pictures of your heart.
  
  
• MRI: This test is also called magnetic resonance (REH-zuh-nuns) imaging. MRI allows your caregivers to see inside your body. During the MRI pictures are taken of your aortic valve. Caregivers use these pictures to look for aortic regurgitation.

How will my AR be treated?

Treatment of AR depends on your signs and symptoms. You may have one or more of the following treatments:

• Antibiotic (an-ti-bi-AH-tik) medicine.
  
  
• Diuretic medicine (water pills).
  
  
• Heart medicine.
  
  
• Blood thinning medicine.
  
  
• Low sodium diet.
  
  
• Surgery to repair or replace the aortic valve.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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